Provider Demographics
NPI:1669522785
Name:CARR, LAURA MADDOX (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MADDOX
Last Name:CARR
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 1:3100 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8426
Mailing Address - Country:US
Mailing Address - Phone:919-363-5000
Mailing Address - Fax:919-363-5346
Practice Address - Street 1:3100 NC HIGHWAY 55
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8426
Practice Address - Country:US
Practice Address - Phone:919-363-5000
Practice Address - Fax:919-363-5346
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412015Medicaid