Provider Demographics
NPI:1427198282
Name:MASON, LAUREL ANN (SLP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1602
Mailing Address - Country:US
Mailing Address - Phone:805-928-4465
Mailing Address - Fax:805-928-7935
Practice Address - Street 1:2530 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1602
Practice Address - Country:US
Practice Address - Phone:805-928-4465
Practice Address - Fax:805-928-7935
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist