Provider Demographics
NPI:1831538891
Name:LAURITA, WENDY J (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:LAURITA
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 1:528 RUBY VISTA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4101
Mailing Address - Country:US
Mailing Address - Phone:702-858-9962
Mailing Address - Fax:702-304-0798
Practice Address - Street 1:528 RUBY VISTA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4101
Practice Address - Country:US
Practice Address - Phone:702-858-9962
Practice Address - Fax:702-304-0798
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist