Provider Demographics
NPI:1043356991
Name:MORAN, LAURA LEE (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:MORAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3927
Mailing Address - Country:US
Mailing Address - Phone:321-363-6675
Mailing Address - Fax:
Practice Address - Street 1:648 BLUEBIRD CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3927
Practice Address - Country:US
Practice Address - Phone:321-363-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892485600Medicaid