Provider Demographics
NPI:1073081626
Name:LAURENCIO, MA CONCEPCION SEGISMUNDO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MA CONCEPCION
Middle Name:SEGISMUNDO
Last Name:LAURENCIO
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 1:149 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3349
Mailing Address - Country:US
Mailing Address - Phone:202-290-7440
Mailing Address - Fax:
Practice Address - Street 1:4300 WICOMICO AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2673
Practice Address - Country:US
Practice Address - Phone:301-572-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty