Provider Demographics
NPI:1033385760
Name:KING, LAURA SMITH (MS CCC, SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SMITH
Last Name:KING
Suffix:
Gender:F
Credentials:MS CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 EVANGELINE WAY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-4402
Mailing Address - Country:US
Mailing Address - Phone:205-759-9374
Mailing Address - Fax:
Practice Address - Street 1:4340 EVANGELINE WAY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-4402
Practice Address - Country:US
Practice Address - Phone:205-759-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist