Provider Demographics
NPI:1033721030
Name:BUESCHER, LAURA KELLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KELLY
Last Name:BUESCHER
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 1:5601 CENTRAL FWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76305-6609
Mailing Address - Country:US
Mailing Address - Phone:443-523-5545
Mailing Address - Fax:
Practice Address - Street 1:3550 STEVENS CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1031
Practice Address - Country:US
Practice Address - Phone:408-244-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist