Provider Demographics
NPI:1124422159
Name:COONEY JAMESON, LAURA LOUISE (SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:COONEY JAMESON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LOUISE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:725 MARIANA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4778
Mailing Address - Country:US
Mailing Address - Phone:573-356-2724
Mailing Address - Fax:
Practice Address - Street 1:204 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4822
Practice Address - Country:US
Practice Address - Phone:573-639-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist