Provider Demographics
NPI:1154524957
Name:FOLSOM, LAURA ANNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15436 N.1ST PL.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3002
Mailing Address - Country:US
Mailing Address - Phone:602-978-0529
Mailing Address - Fax:
Practice Address - Street 1:4545 E SHEA BLVD STE 169
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3061
Practice Address - Country:US
Practice Address - Phone:602-765-6929
Practice Address - Fax:602-494-2930
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP0461OtherSPEECH LANGUAGE PATHOLOGI