Provider Demographics
NPI:1629243399
Name:KAPUSTA, LAURI ANN (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:ANN
Last Name:KAPUSTA
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MOUNT VERNON HIGHWAY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-252-7368
Mailing Address - Fax:404-256-7368
Practice Address - Street 1:755 MOUNT VERNON HIGHWAY
Practice Address - Street 2:SUITE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-252-7368
Practice Address - Fax:404-256-7368
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003684231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist