Provider Demographics
NPI:1518466788
Name:BACIA, LAURA RACHEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RACHEL
Last Name:BACIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 SPRING BUCK TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8523
Mailing Address - Country:US
Mailing Address - Phone:407-538-1562
Mailing Address - Fax:
Practice Address - Street 1:10640 SPRING BUCK TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8523
Practice Address - Country:US
Practice Address - Phone:407-538-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist