Provider Demographics
NPI:1457371999
Name:KAUTH, LAURA ST (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ST
Last Name:KAUTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E 52ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2786
Mailing Address - Country:US
Mailing Address - Phone:563-355-7712
Mailing Address - Fax:563-359-1325
Practice Address - Street 1:2215 E 52ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2786
Practice Address - Country:US
Practice Address - Phone:563-355-7712
Practice Address - Fax:563-359-1325
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA509231H00000X
IA786237700000X
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0236778Medicaid
IA05573OtherNATIONAL EAR CARE PLAN
IA211928OtherIOWA HEALTH SOLUTIONS
IAI4506Medicare ID - Type Unspecified
IA0236778Medicaid