Provider Demographics
NPI:1285815498
Name:MOWRY, LAINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAINE
Middle Name:
Last Name:MOWRY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TERN DR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-6106
Mailing Address - Country:US
Mailing Address - Phone:401-226-7051
Mailing Address - Fax:
Practice Address - Street 1:800 QUAKER LN
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1667
Practice Address - Country:US
Practice Address - Phone:401-886-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist