Provider Demographics
NPI:1912217290
Name:GARDNER, LAURA LEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEIGH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SPRING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8792
Mailing Address - Country:US
Mailing Address - Phone:843-851-9084
Mailing Address - Fax:
Practice Address - Street 1:221 STALLSVILLE RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4934
Practice Address - Country:US
Practice Address - Phone:843-832-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist