Provider Demographics
NPI:1205379559
Name:ELZBY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ELZBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12062 VALLEY VIEW ST
Mailing Address - Street 2:STE 137
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1741
Mailing Address - Country:US
Mailing Address - Phone:714-901-1518
Mailing Address - Fax:714-901-1359
Practice Address - Street 1:12062 VALLEY VIEW STREET
Practice Address - Street 2:SUITE 137
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-901-1518
Practice Address - Fax:714-901-1359
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist