Provider Demographics
NPI:1508078957
Name:EDMOND, LAURIE K (MAT CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:K
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MAT CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ANDREA CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7757
Mailing Address - Country:US
Mailing Address - Phone:219-476-4144
Mailing Address - Fax:
Practice Address - Street 1:32772 DEER WATCH CT
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9690
Practice Address - Country:US
Practice Address - Phone:574-654-8540
Practice Address - Fax:574-654-9183
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist