Provider Demographics
NPI: | 1356482863 |
---|---|
Name: | O'DWYER, LAURA ANN (MS, CCC-SLP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | LAURA |
Middle Name: | ANN |
Last Name: | O'DWYER |
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: | 3325 N UNIVERSITY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CORAL SPRINGS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33065-4162 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-344-6550 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3325 N UNIVERSITY DR |
Practice Address - Street 2: | |
Practice Address - City: | CORAL SPRINGS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33065-4162 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-344-6550 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-08 |
Last Update Date: | 2018-12-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | SA 8418 | 235Z00000X |
222Q00000X, 103K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |