Provider Demographics
NPI:1497855654
Name:MIDGETTE, LAURIE LAZAR (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LAZAR
Last Name:MIDGETTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WINDSOR PARK LN
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2704
Mailing Address - Country:US
Mailing Address - Phone:610-574-8465
Mailing Address - Fax:
Practice Address - Street 1:111 ELWYN RD
Practice Address - Street 2:YAGO BUILDING, B1
Practice Address - City:ELWYN
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2209
Practice Address - Fax:610-891-7000
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000208L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist