Provider Demographics
NPI:1831601780
Name:FROELICH, LAURA W (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:W
Last Name:FROELICH
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 1:101 E VIENNA DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-3511
Mailing Address - Country:US
Mailing Address - Phone:815-546-7339
Mailing Address - Fax:
Practice Address - Street 1:2100 E MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1342
Practice Address - Country:US
Practice Address - Phone:512-900-7934
Practice Address - Fax:512-900-7954
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist