Provider Demographics
NPI:1841937521
Name:DIAS, LAURA JEANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEANNE
Last Name:DIAS
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 1:356 NEWTOWN TPKE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3606
Mailing Address - Country:US
Mailing Address - Phone:914-438-6542
Mailing Address - Fax:
Practice Address - Street 1:356 NEWTOWN TPKE
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3606
Practice Address - Country:US
Practice Address - Phone:914-438-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist