Provider Demographics
NPI:1811093784
Name:NELSON, LAURIE ELLEN (MS)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 WHITLOCK AVE SW STE A36
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4654
Mailing Address - Country:US
Mailing Address - Phone:770-427-3033
Mailing Address - Fax:770-427-3035
Practice Address - Street 1:707 WHITLOCK AVE SW STE A36
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4654
Practice Address - Country:US
Practice Address - Phone:770-427-3033
Practice Address - Fax:770-427-3035
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1814231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000817847EMedicaid
GA64BCBHMMedicare UPIN
GAS81808Medicare UPIN