Provider Demographics
NPI:1275178287
Name:WEISS, LAURA CHACON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHACON
Last Name:WEISS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CHACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9846 HWY 31 E
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75705-2329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9846 HWY 31 E
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75705-2329
Practice Address - Country:US
Practice Address - Phone:903-592-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2023-02-28
Deactivation Date:2023-01-11
Deactivation Code:
Reactivation Date:2023-02-23
Provider Licenses
StateLicense IDTaxonomies
TX119230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist