Provider Demographics
NPI:1821303249
Name:MYERS, LAURA MICHELE (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELE
Last Name:MYERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15815 S LAKEWOOD PKWY W APT 1105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7290
Mailing Address - Country:US
Mailing Address - Phone:765-210-8831
Mailing Address - Fax:
Practice Address - Street 1:15815 S LAKEWOOD PKWY W APT 1105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7290
Practice Address - Country:US
Practice Address - Phone:765-210-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist