Provider Demographics
NPI:1295064327
Name:STAPLES, LAURA JAN (MSCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JAN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STRATTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1923
Mailing Address - Country:US
Mailing Address - Phone:978-376-4370
Mailing Address - Fax:
Practice Address - Street 1:16 STRATTON HILL RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1923
Practice Address - Country:US
Practice Address - Phone:978-376-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist