Provider Demographics
NPI:1316403462
Name:LAWRENCE, LAURA SYD (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SYD
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 W FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4803
Mailing Address - Country:US
Mailing Address - Phone:908-265-0508
Mailing Address - Fax:
Practice Address - Street 1:1163 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4803
Practice Address - Country:US
Practice Address - Phone:908-265-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist