Provider Demographics
NPI:1801672811
Name:CORRIGAN, LAURA (MT-BC, SCMT, NMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:MT-BC, SCMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12558 S PONY EXPRESS RD APT 365
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1959
Mailing Address - Country:US
Mailing Address - Phone:801-540-0758
Mailing Address - Fax:
Practice Address - Street 1:14241 S REDWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5223
Practice Address - Country:US
Practice Address - Phone:385-342-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12498719-4010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist