Provider Demographics
NPI:1598201923
Name:LAIDLOW, JEWEL (HAD)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:LAIDLOW
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 FROST ST STE 420
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2765
Mailing Address - Country:US
Mailing Address - Phone:858-569-6090
Mailing Address - Fax:858-569-0672
Practice Address - Street 1:7910 FROST ST STE 420
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2765
Practice Address - Country:US
Practice Address - Phone:858-569-6090
Practice Address - Fax:858-569-0672
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAD8183237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist