Provider Demographics
NPI:1790995702
Name:BRAVERMAN, LAUREL IMHOFF (AUD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:IMHOFF
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:E
Other - Last Name:IMHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8703 STONEWALL RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8325
Mailing Address - Country:US
Mailing Address - Phone:703-369-3500
Mailing Address - Fax:
Practice Address - Street 1:8703 STONEWALL RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8325
Practice Address - Country:US
Practice Address - Phone:703-369-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001448231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist