Provider Demographics
NPI:1861511867
Name:SERRA, LAURIE L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:SERRA
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 1:3321 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2016
Mailing Address - Country:US
Mailing Address - Phone:727-424-6906
Mailing Address - Fax:727-787-8861
Practice Address - Street 1:3321 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2016
Practice Address - Country:US
Practice Address - Phone:727-424-6906
Practice Address - Fax:727-787-8861
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist