Provider Demographics
NPI:1497073670
Name:METTLER, LAURA LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:METTLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2404 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4646
Mailing Address - Country:US
Mailing Address - Phone:402-379-0505
Mailing Address - Fax:402-379-0555
Practice Address - Street 1:2404 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4646
Practice Address - Country:US
Practice Address - Phone:402-379-0505
Practice Address - Fax:402-379-0555
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE479OtherSPEECH-LANGUAGE PATHOLOGIST LICENSE