Provider Demographics
NPI:1639433501
Name:OVERTON, LAURA (MA, CCC-SLP, BRS-FD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BRS-FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3246
Mailing Address - Country:US
Mailing Address - Phone:817-915-0901
Mailing Address - Fax:
Practice Address - Street 1:1709 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3246
Practice Address - Country:US
Practice Address - Phone:817-915-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist