Provider Demographics
NPI:1598204026
Name:ELDRIDGE, LAURA E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 EAST MAIN SREET SUITE 202
Mailing Address - Street 2:
Mailing Address - City:ARON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-965-2103
Mailing Address - Fax:860-217-0742
Practice Address - Street 1:56 EAST MAIN SREET SUITE 202
Practice Address - Street 2:
Practice Address - City:ARON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-965-2103
Practice Address - Fax:860-217-0742
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist