Provider Demographics
NPI:1619367380
Name:CARLSON, LAURA (M,A, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:M,A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18603 POPLAR GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11908 BRISTOL MANOR CT
Practice Address - Street 2:
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-5804
Practice Address - Country:US
Practice Address - Phone:301-881-1394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency