Provider Demographics
NPI:1437740651
Name:GEISSERT, LAURA BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:GEISSERT
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 1:10830 KLING ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1598
Mailing Address - Country:US
Mailing Address - Phone:559-246-7152
Mailing Address - Fax:
Practice Address - Street 1:10830 KLING ST UNIT 103
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-1598
Practice Address - Country:US
Practice Address - Phone:559-246-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist