Provider Demographics
NPI:1326320011
Name:LAURET, MICHELE SUZANNE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:SUZANNE
Last Name:LAURET
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:SUZANNE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2424 GRAYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9452
Mailing Address - Country:US
Mailing Address - Phone:240-994-6342
Mailing Address - Fax:
Practice Address - Street 1:2814A WILDWOOD CT
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8003
Practice Address - Country:US
Practice Address - Phone:301-845-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06049OtherDEPARTMENT OF HEALTH AND MENTAL HYGIENE