Provider Demographics
NPI:1164684098
Name:DEAN, LAURIE N (MS SLP-CCC)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:N
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23030 E COUNTY ROAD 2100N
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61943-6849
Mailing Address - Country:US
Mailing Address - Phone:217-346-2766
Mailing Address - Fax:
Practice Address - Street 1:23030 E COUNTY ROAD 2100N
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IL
Practice Address - Zip Code:61943-6849
Practice Address - Country:US
Practice Address - Phone:217-346-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist