Provider Demographics
NPI:1255683793
Name:LUDLOW, LAURA WITTWER (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:WITTWER
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11461 SYLVANITE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2523
Mailing Address - Country:US
Mailing Address - Phone:714-717-7446
Mailing Address - Fax:
Practice Address - Street 1:11461 SYLVANITE CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2523
Practice Address - Country:US
Practice Address - Phone:714-717-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist