Provider Demographics
NPI:1578139572
Name:RAULERSON, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RAULERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EAST CAPRI CIRCLE
Mailing Address - Street 2:APT 120C
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724
Mailing Address - Country:US
Mailing Address - Phone:386-473-9003
Mailing Address - Fax:
Practice Address - Street 1:145 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3594
Practice Address - Country:US
Practice Address - Phone:407-323-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist