Provider Demographics
NPI:1245300698
Name:DUNLAP, LAURIE HANSON (MS)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:HANSON
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3330
Mailing Address - Country:US
Mailing Address - Phone:903-733-5829
Mailing Address - Fax:870-779-8688
Practice Address - Street 1:2414 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-3330
Practice Address - Country:US
Practice Address - Phone:903-733-5829
Practice Address - Fax:903-733-5829
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2245235Z00000X
TX101814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157520721Medicaid
TX8T3906OtherTX BCBS
TX021289601Medicaid
AR5Y289OtherAR BCBS