Provider Demographics
NPI:1588799092
Name:STEVENSON, LAURA A (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:14955 W BELL RD
Mailing Address - Street 2:UNIT 7951
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8240
Mailing Address - Country:US
Mailing Address - Phone:602-664-7400
Mailing Address - Fax:
Practice Address - Street 1:14955 W BELL RD
Practice Address - Street 2:UNIT 7951
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8240
Practice Address - Country:US
Practice Address - Phone:602-664-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ560755OtherAHCCCS