Provider Demographics
NPI:1376706549
Name:ANDERSON, LAURA JEAN (MA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6980 WINTON BLOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3556
Mailing Address - Country:US
Mailing Address - Phone:334-277-0484
Mailing Address - Fax:334-272-8877
Practice Address - Street 1:6980 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3556
Practice Address - Country:US
Practice Address - Phone:334-277-0484
Practice Address - Fax:334-272-8877
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL279231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist