Provider Demographics
NPI:1225122575
Name:HILL, LAURA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GLESSNER AVE
Mailing Address - Street 2:SPEECH THERAPY DEPARTMENT
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2269
Mailing Address - Country:US
Mailing Address - Phone:419-526-8290
Mailing Address - Fax:419-520-2878
Practice Address - Street 1:335 GLESSNER AVE
Practice Address - Street 2:SPEECH THERAPY DEPARTMENT
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2269
Practice Address - Country:US
Practice Address - Phone:419-526-8290
Practice Address - Fax:419-520-2878
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0914235Z00000X
OHSP. 9065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7403136000Medicaid