Provider Demographics
NPI:1609094143
Name:KOH, LAURA ANNE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:KOH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SANDUSKY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:44865-1133
Mailing Address - Country:US
Mailing Address - Phone:419-929-1563
Mailing Address - Fax:
Practice Address - Street 1:1069 US HIGHWAY 224
Practice Address - Street 2:
Practice Address - City:NOVA
Practice Address - State:OH
Practice Address - Zip Code:44859-9770
Practice Address - Country:US
Practice Address - Phone:419-652-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist