Provider Demographics
NPI:1265663686
Name:TERREBONNE, LAURA R (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:TERREBONNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:ROUSSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 SEMINOLE AVE NE
Mailing Address - Street 2:SUITE T05
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-3408
Mailing Address - Country:US
Mailing Address - Phone:404-575-4000
Mailing Address - Fax:404-575-4010
Practice Address - Street 1:675 SEMINOLE AVE NE
Practice Address - Street 2:SUITE T05
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-3408
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:404-575-4010
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist