Provider Demographics
NPI:1639415011
Name:SERRA, LAURA DENISE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DENISE
Last Name:SERRA
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 EDMUND HWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7332
Mailing Address - Country:US
Mailing Address - Phone:803-318-0885
Mailing Address - Fax:
Practice Address - Street 1:6680 EDMUND HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7332
Practice Address - Country:US
Practice Address - Phone:803-318-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist