Provider Demographics
NPI:1821104571
Name:MONTESANO, LAURA JANE (MA CCC-SLP, MT-BC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:MONTESANO
Suffix:
Gender:F
Credentials:MA CCC-SLP, MT-BC
Other - Prefix:
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Mailing Address - Street 1:6505 KALUA RD APT 203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5809
Mailing Address - Country:US
Mailing Address - Phone:303-882-3123
Mailing Address - Fax:303-993-8706
Practice Address - Street 1:6505 KALUA RD APT 203
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5809
Practice Address - Country:US
Practice Address - Phone:303-882-3123
Practice Address - Fax:303-993-8706
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13657836Medicaid