Provider Demographics
NPI:1992365613
Name:SCHOOK, LAURA CANNON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CANNON
Last Name:SCHOOK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6400 CHRISTIE AVE APT 3102
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1034
Mailing Address - Country:US
Mailing Address - Phone:516-984-6988
Mailing Address - Fax:
Practice Address - Street 1:3666 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2046
Practice Address - Country:US
Practice Address - Phone:510-835-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist