Provider Demographics
NPI:1518326891
Name:ZACHRICH, LAURA I (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ZACHRICH
Suffix:I
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N 075 E
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-9359
Mailing Address - Country:US
Mailing Address - Phone:260-463-7445
Mailing Address - Fax:
Practice Address - Street 1:770 N 075 E
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-9359
Practice Address - Country:US
Practice Address - Phone:260-463-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001610A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist