Provider Demographics
NPI:1689713349
Name:LAUREL, MARCI (SLP)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:LAUREL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MENAUL BLVD NE
Mailing Address - Street 2:CENTER FOR DEVELOPMENT AND DISABILITY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1851
Mailing Address - Country:US
Mailing Address - Phone:505-272-9015
Mailing Address - Fax:
Practice Address - Street 1:2300 MENAUL BLVD NE
Practice Address - Street 2:CENTER FOR DEVELOPMENT AND DISABILITY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1851
Practice Address - Country:US
Practice Address - Phone:505-272-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML 6062Medicaid