Provider Demographics
NPI:1750531950
Name:FRAGOMENI, LAURA LEA (AUD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:FRAGOMENI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 CLEARVISTA PKWY STE 8B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1456
Mailing Address - Country:US
Mailing Address - Phone:173-436-8306
Mailing Address - Fax:317-436-8462
Practice Address - Street 1:8202 CLEARVISTA PKWY STE 8B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1456
Practice Address - Country:US
Practice Address - Phone:317-436-8306
Practice Address - Fax:317-436-8462
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002438A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN23002438AOtherINDIANA HEALTH PROFESSIONS BUREAU