Provider Demographics
NPI:1689608663
Name:DUNDAS, LAURA IVEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:IVEY
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:696 PETALUMA BLVD N
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2847
Mailing Address - Country:US
Mailing Address - Phone:707-763-3161
Mailing Address - Fax:707-763-9829
Practice Address - Street 1:696 PETALUMA BLVD N
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2847
Practice Address - Country:US
Practice Address - Phone:707-763-3161
Practice Address - Fax:707-763-9829
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005897231H00000X
CA2964231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist