Provider Demographics
NPI:1720658909
Name:MCDONALD, LAURA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:IA
Mailing Address - Zip Code:52227-1200
Mailing Address - Country:US
Mailing Address - Phone:401-741-3197
Mailing Address - Fax:319-200-2009
Practice Address - Street 1:1717 BOYSON RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2313
Practice Address - Country:US
Practice Address - Phone:319-200-2004
Practice Address - Fax:319-200-2009
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist