Provider Demographics
NPI:1841772993
Name:LAPLACA, MARY GRACE (MA, CCC- SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:LAPLACA
Suffix:
Gender:F
Credentials:MA, CCC- SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MISTY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4452
Mailing Address - Country:US
Mailing Address - Phone:215-870-7125
Mailing Address - Fax:
Practice Address - Street 1:115 MISTY MEADOW LN
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-4452
Practice Address - Country:US
Practice Address - Phone:215-870-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PASL000847L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst