Provider Demographics
NPI:1952711673
Name:CUSTER, LAURA LYNN (M ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:CUSTER
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 37TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2109
Mailing Address - Country:US
Mailing Address - Phone:206-972-8624
Mailing Address - Fax:
Practice Address - Street 1:2726 37TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2109
Practice Address - Country:US
Practice Address - Phone:206-972-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist