Provider Demographics
NPI:1407277742
Name:FARRELL LALU, LAURAL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURAL
Middle Name:
Last Name:FARRELL LALU
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 1:296 PATRICKS XING
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2606
Mailing Address - Country:US
Mailing Address - Phone:757-945-8091
Mailing Address - Fax:
Practice Address - Street 1:1769 JAMESTOWN RD STE 217
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2307
Practice Address - Country:US
Practice Address - Phone:757-945-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10612235Z00000X
VA2202007077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist