Provider Demographics
NPI:1154899839
Name:DAVIS, LAURA NEWMAN (SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NEWMAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AFTONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-2702
Mailing Address - Country:US
Mailing Address - Phone:336-793-6939
Mailing Address - Fax:
Practice Address - Street 1:3523 ELKIN HWY 268
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8322
Practice Address - Country:US
Practice Address - Phone:336-793-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC11941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist