Provider Demographics
NPI:1861036600
Name:RIBEIRO, LAURA MITCHELL (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MITCHELL
Last Name:RIBEIRO
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 1:120 DEAN ST APT 304B
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2768
Mailing Address - Country:US
Mailing Address - Phone:508-577-3980
Mailing Address - Fax:
Practice Address - Street 1:1 RANDALL SQ STE 302
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-433-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16932355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant