Provider Demographics
NPI:1508290065
Name:RAU, LAURIE ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:RAU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ELLEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7360 JOSHUA PL
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3406
Mailing Address - Country:US
Mailing Address - Phone:321-504-3884
Mailing Address - Fax:
Practice Address - Street 1:7360 JOSHUA PL
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3406
Practice Address - Country:US
Practice Address - Phone:321-504-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist