Provider Demographics
NPI:1083879233
Name:PASSERMAN, LAURA CATHERINE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CATHERINE
Last Name:PASSERMAN
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 1:653 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3359
Mailing Address - Country:US
Mailing Address - Phone:815-941-2357
Mailing Address - Fax:
Practice Address - Street 1:653 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3359
Practice Address - Country:US
Practice Address - Phone:815-941-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146006077OtherSPEECH LANGUAGE PATHOLOGY LICENSE