Provider Demographics
NPI:1144763707
Name:SODETANI, LAURIE (SLP CCC-MA)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:SODETANI
Suffix:
Gender:F
Credentials:SLP CCC-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 KUMUKOA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4028
Mailing Address - Country:US
Mailing Address - Phone:808-934-0633
Mailing Address - Fax:
Practice Address - Street 1:886 KUMUKOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4028
Practice Address - Country:US
Practice Address - Phone:808-934-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP 268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist