Provider Demographics
NPI:1679944409
Name:GIRARD, LAURENT DOMINIQUE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURENT
Middle Name:DOMINIQUE
Last Name:GIRARD
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 JASMINE AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5916
Mailing Address - Country:US
Mailing Address - Phone:310-237-2974
Mailing Address - Fax:
Practice Address - Street 1:3742 JASMINE AVE
Practice Address - Street 2:APT 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5916
Practice Address - Country:US
Practice Address - Phone:310-237-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist