Provider Demographics
NPI:1942701495
Name:SHULTS, LAURA W (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:W
Last Name:SHULTS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MR
Other - First Name:LAURA
Other - Middle Name:W
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:113 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2905
Mailing Address - Country:US
Mailing Address - Phone:315-430-6886
Mailing Address - Fax:
Practice Address - Street 1:187 NORTHERN CONCOURSE
Practice Address - Street 2:OPWDD
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-473-6944
Practice Address - Fax:315-473-3186
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist