Provider Demographics
NPI:1144393885
Name:PETT, LAURA MARIE (MA CCC A)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:PETT
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:35121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:5950 CLEARWATER DRIVE
Practice Address - Street 2:CHILDRENS HOSPITALS AND CLINICS COMMUNITY REHAB
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343
Practice Address - Country:US
Practice Address - Phone:952-930-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7653231H00000X, 237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist