Provider Demographics
NPI:1407105042
Name:BURNER, LAURA E (MA,SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:BURNER
Suffix:
Gender:F
Credentials:MA,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 E ROYALTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2868
Mailing Address - Country:US
Mailing Address - Phone:440-838-0990
Mailing Address - Fax:440-838-8440
Practice Address - Street 1:1929 E ROYALTON RD STE A
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2868
Practice Address - Country:US
Practice Address - Phone:440-838-0990
Practice Address - Fax:440-838-8440
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.-2013121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid