Provider Demographics
NPI:1255340584
Name:GARNER, LAURA JEAN (SLP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:GARNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 CLOUDY SKY LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5530
Mailing Address - Country:US
Mailing Address - Phone:972-315-3130
Mailing Address - Fax:
Practice Address - Street 1:724 W MAIN ST
Practice Address - Street 2:STE 180
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3514
Practice Address - Country:US
Practice Address - Phone:972-434-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15676OtherSPEECH THERAPIST