Provider Demographics
NPI:1558790881
Name:GILCHRIST, LAURIE (MSCCCSLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27407 STARLIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-7864
Mailing Address - Country:US
Mailing Address - Phone:417-987-1212
Mailing Address - Fax:
Practice Address - Street 1:701 SUNSET HILLS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2165
Practice Address - Country:US
Practice Address - Phone:660-385-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013018884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist