Provider Demographics
NPI:1851804496
Name:GRANT, LAURA (PHD, CF-SLP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 BROOKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1657
Mailing Address - Country:US
Mailing Address - Phone:630-201-7710
Mailing Address - Fax:
Practice Address - Street 1:3501 BLAINE RD
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-9467
Practice Address - Country:US
Practice Address - Phone:815-765-9436
Practice Address - Fax:815-765-9436
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist