Provider Demographics
NPI:1275866642
Name:MCBRIDE, LAURA A (MA, CCC-SLP, LLC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MA, CCC-SLP, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48804-1493
Mailing Address - Country:US
Mailing Address - Phone:989-772-5512
Mailing Address - Fax:
Practice Address - Street 1:1500 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3028
Practice Address - Country:US
Practice Address - Phone:989-772-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist