Provider Demographics
NPI:1770988420
Name:NAZAROFF, LAURA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NAZAROFF
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MENDRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2265 W ROBINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2828
Mailing Address - Country:US
Mailing Address - Phone:559-351-0566
Mailing Address - Fax:
Practice Address - Street 1:3034 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0300
Practice Address - Country:US
Practice Address - Phone:559-321-0883
Practice Address - Fax:559-321-2692
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2278G0305X
CA18605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2278G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeriatric Care