Provider Demographics
NPI:1780987271
Name:WELLS, LAURIE ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:WELLS
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 1:1985 FLASHY LN
Mailing Address - Street 2:FL
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3143
Mailing Address - Country:US
Mailing Address - Phone:321-241-4816
Mailing Address - Fax:321-241-4817
Practice Address - Street 1:2226 SARNO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3087
Practice Address - Country:US
Practice Address - Phone:321-241-4816
Practice Address - Fax:321-241-4817
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA10305OtherDOH (FL)