Provider Demographics
NPI:1154802155
Name:BAILEY, LAURA MARGUERITE GOGGIN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGUERITE GOGGIN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11513 GUERNSEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3706
Mailing Address - Country:US
Mailing Address - Phone:260-437-6416
Mailing Address - Fax:
Practice Address - Street 1:3405 EL SALIDO PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5640
Practice Address - Country:US
Practice Address - Phone:512-402-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010216235Z00000X
TX116553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist