Provider Demographics
NPI:1679649800
Name:PADGETT, LAURA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:PADGETT
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-0038
Mailing Address - Country:US
Mailing Address - Phone:520-366-6204
Mailing Address - Fax:520-366-0313
Practice Address - Street 1:10385 E HWY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8370
Practice Address - Country:US
Practice Address - Phone:520-366-6204
Practice Address - Fax:520-366-0313
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6387235Z00000X
FLSA5892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812014500Medicaid
FL891556300Medicaid
FLS9320OtherBCBS OF FLORIDA