Provider Demographics
NPI:1710138086
Name:BECKER, LAURA B (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:BECKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WELLS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3302
Mailing Address - Country:US
Mailing Address - Phone:617-630-4976
Mailing Address - Fax:617-964-9355
Practice Address - Street 1:120 WELLS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3302
Practice Address - Country:US
Practice Address - Phone:617-630-4976
Practice Address - Fax:617-964-9355
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist