Provider Demographics
NPI:1073842464
Name:KAUTZMAN, LAURA KATHERINE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHERINE
Last Name:KAUTZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:KATHERINE
Other - Last Name:KAUTZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT,CCC, SLP
Mailing Address - Street 1:4043 BRENTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4220
Mailing Address - Country:US
Mailing Address - Phone:907-248-3759
Mailing Address - Fax:907-245-5535
Practice Address - Street 1:4043 BRENTWOOD CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4220
Practice Address - Country:US
Practice Address - Phone:907-248-3759
Practice Address - Fax:907-245-5535
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK423669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist