Provider Demographics
NPI:1093974594
Name:MCCARTHY, LAURA J (MSCCC SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4810 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1229
Mailing Address - Country:US
Mailing Address - Phone:208-514-9243
Mailing Address - Fax:208-577-6700
Practice Address - Street 1:2300 S ORCHARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6722
Practice Address - Country:US
Practice Address - Phone:208-514-9243
Practice Address - Fax:208-577-6700
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist