Provider Demographics
NPI:1760083430
Name:GALLUPS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GALLUPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 BARBED WIRE WAY
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4859
Mailing Address - Country:US
Mailing Address - Phone:817-937-9406
Mailing Address - Fax:
Practice Address - Street 1:25 LEONARD TRL
Practice Address - Street 2:
Practice Address - City:WESTWORTH VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76114-4037
Practice Address - Country:US
Practice Address - Phone:682-282-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist