Provider Demographics
NPI:1154823839
Name:CACIOLO, LAURA (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CACIOLO
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 HUFFS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504-9019
Mailing Address - Country:US
Mailing Address - Phone:267-347-2694
Mailing Address - Fax:
Practice Address - Street 1:1208 HUFFS CHURCH RD
Practice Address - Street 2:
Practice Address - City:BARTO
Practice Address - State:PA
Practice Address - Zip Code:19504-9019
Practice Address - Country:US
Practice Address - Phone:267-347-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SL013288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty