Provider Demographics
NPI:1033190194
Name:CHETWYND, LAURALYN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURALYN
Middle Name:
Last Name:CHETWYND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOPE AVENUE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON AT WALTHAM
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-216-2207
Mailing Address - Fax:781-216-2252
Practice Address - Street 1:9 HOPE AVENUE
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON AT WALTHAM
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-216-2207
Practice Address - Fax:781-216-2252
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA767231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2063310Medicaid
MACH 040064Medicare ID - Type UnspecifiedAUDIOLOGIST