Provider Demographics
NPI:1184882821
Name:MAYBERRY, LAURA HASKELL
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:HASKELL
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:MCKENZIE
Other - Last Name:HASKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 HEATHERMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7657
Mailing Address - Country:US
Mailing Address - Phone:864-608-1919
Mailing Address - Fax:
Practice Address - Street 1:239 HEATHERMOOR WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7657
Practice Address - Country:US
Practice Address - Phone:864-608-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist