Provider Demographics
NPI:1982003588
Name:WACTOWSKI, LAURA C (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:WACTOWSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 NORTHEASTERN BLVD
Mailing Address - Street 2:SUITE 21B
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3192
Mailing Address - Country:US
Mailing Address - Phone:603-882-4500
Mailing Address - Fax:
Practice Address - Street 1:74 NORTHEASTERN BLVD
Practice Address - Street 2:SUITE 21B
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3192
Practice Address - Country:US
Practice Address - Phone:603-882-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1559235Z00000X
MA8688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist