Provider Demographics
NPI:1184917684
Name:SIEVERS, LAURA L (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2359
Mailing Address - Country:US
Mailing Address - Phone:731-668-6076
Mailing Address - Fax:731-668-7033
Practice Address - Street 1:65 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2359
Practice Address - Country:US
Practice Address - Phone:731-668-6076
Practice Address - Fax:731-668-7033
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNA0000001602231H00000X
CACA0000001826231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist