Provider Demographics
NPI:1225387681
Name:CLELLAND, LAURA (CPED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CLELLAND
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-6947
Mailing Address - Country:US
Mailing Address - Phone:928-221-3277
Mailing Address - Fax:866-595-4526
Practice Address - Street 1:1900 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-6947
Practice Address - Country:US
Practice Address - Phone:928-221-3277
Practice Address - Fax:866-595-4526
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZABC2482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist