Provider Demographics
NPI:1104142066
Name:LAUDAL, KAELA M (SLP)
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:M
Last Name:LAUDAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KAELA
Other - Middle Name:M
Other - Last Name:LAUDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5481 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6071
Mailing Address - Country:US
Mailing Address - Phone:701-629-0400
Mailing Address - Fax:
Practice Address - Street 1:207 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1725
Practice Address - Country:US
Practice Address - Phone:701-356-2000
Practice Address - Fax:701-356-2009
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP 1959235Z00000X
ND235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist