Provider Demographics
NPI:1891261707
Name:XIAO, LAURA NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:XIAO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 MADISON RIDGE HTS APT C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2733
Mailing Address - Country:US
Mailing Address - Phone:631-848-5713
Mailing Address - Fax:
Practice Address - Street 1:7092 HARR AVE BLDG 6492
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80902-2190
Practice Address - Country:US
Practice Address - Phone:719-524-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO0003821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program