Provider Demographics
NPI:1750704938
Name:VANDERHEIJDEN, LAURA LEE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:VANDERHEIJDEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W CROSSVILLE RD
Mailing Address - Street 2:UNIT # 104
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2694
Mailing Address - Country:US
Mailing Address - Phone:404-547-0825
Mailing Address - Fax:770-783-6618
Practice Address - Street 1:570 W CROSSVILLE RD
Practice Address - Street 2:UNIT # 104
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2694
Practice Address - Country:US
Practice Address - Phone:404-547-0825
Practice Address - Fax:770-783-6618
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist