Provider Demographics
NPI:1811235344
Name:WITT-MYERS, LAURIE C (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:C
Last Name:WITT-MYERS
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 1:1905 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2442
Mailing Address - Country:US
Mailing Address - Phone:360-693-9578
Mailing Address - Fax:
Practice Address - Street 1:630 24TH ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1652
Practice Address - Country:US
Practice Address - Phone:360-954-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist