Provider Demographics
NPI:1518016641
Name:RABY, LAURA ANN (MCD, CCD-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:RABY
Suffix:
Gender:F
Credentials:MCD, CCD-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3638
Mailing Address - Country:US
Mailing Address - Phone:423-304-3116
Mailing Address - Fax:205-621-6507
Practice Address - Street 1:1218 MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3638
Practice Address - Country:US
Practice Address - Phone:423-304-3116
Practice Address - Fax:205-621-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2494235Z00000X
TNSP0000003775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536057OtherBLUE CROSS BLUE SHEILD
AL890013630Medicaid