Provider Demographics
NPI:1033432760
Name:BARNETT, LAURA LEE (MCSD/CCC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MCSD/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FAIRFAX ROAD AT VIRGINIA STREET
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4399
Mailing Address - Country:US
Mailing Address - Phone:801-536-3610
Mailing Address - Fax:
Practice Address - Street 1:FAIRFAX ROAD AT VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4399
Practice Address - Country:US
Practice Address - Phone:801-536-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1108054102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist