Provider Demographics
NPI:1710040373
Name:ROSS-BRENNAN, LAURIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:ROSS-BRENNAN
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 1:7412 ARROYO DEL OSO AVE NE
Mailing Address - Street 2:4210 LOUISIANA NE SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2927
Mailing Address - Country:US
Mailing Address - Phone:505-450-2922
Mailing Address - Fax:505-268-0184
Practice Address - Street 1:4210 LOUISIANA BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1807
Practice Address - Country:US
Practice Address - Phone:505-268-5933
Practice Address - Fax:505-268-0184
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist