Provider Demographics
NPI:1558405886
Name:TOWNSEND, LAURA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials: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:PO BOX 1723
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1723
Mailing Address - Country:US
Mailing Address - Phone:888-273-8628
Mailing Address - Fax:
Practice Address - Street 1:2309 WATERS RUN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2529
Practice Address - Country:US
Practice Address - Phone:888-273-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00806374CMedicaid
GA000806374DMedicaid