Provider Demographics
NPI:1407417934
Name:LAING, JACQUELYN RACHEL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RACHEL
Last Name:LAING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:RACHEL
Other - Last Name:LAING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9675 BRIGHTON WAY STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5132
Practice Address - Country:US
Practice Address - Phone:310-281-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist