Provider Demographics
NPI:1871040303
Name:LAIRD, JANE ELLEN (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELLEN
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W. HIGH STREET
Mailing Address - Street 2:WEST INTERMEDIATE SCHOOL
Mailing Address - City:ST. MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885
Mailing Address - Country:US
Mailing Address - Phone:419-394-2016
Mailing Address - Fax:419-394-1851
Practice Address - Street 1:1301 W HIGH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2077
Practice Address - Country:US
Practice Address - Phone:419-394-2016
Practice Address - Fax:419-394-1851
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP3763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist