Provider Demographics
NPI:1316384076
Name:WOLFORD, LAURA LIN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LIN
Last Name:WOLFORD
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 1:19555 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4202 E CACTUS RD
Practice Address - Street 2:APT #8305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7660
Practice Address - Country:US
Practice Address - Phone:413-667-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist