Provider Demographics
NPI:1801235890
Name:LANGEVIN, LAURA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:LANGEVIN
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 1:9565 HWY 78 BLDG 700 STE 102
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4116
Mailing Address - Country:US
Mailing Address - Phone:843-314-5434
Mailing Address - Fax:
Practice Address - Street 1:9565 HWY 78 BLDG 700
Practice Address - Street 2:SUITE 102
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4116
Practice Address - Country:US
Practice Address - Phone:843-314-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005005235Z00000X
SC6194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist