Provider Demographics
NPI:1891157715
Name:PADHAM, LAURA ANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:PADHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-0023
Mailing Address - Country:US
Mailing Address - Phone:732-691-1204
Mailing Address - Fax:732-942-7225
Practice Address - Street 1:143 W BARNEGAT AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GATE
Practice Address - State:NJ
Practice Address - Zip Code:08740-1307
Practice Address - Country:US
Practice Address - Phone:732-691-1204
Practice Address - Fax:732-732-9413
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist