Provider Demographics
NPI:1194022319
Name:CHIN, LAURA WILTON (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WILTON
Last Name:CHIN
Suffix:
Gender:
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 1:1024 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1332
Mailing Address - Country:US
Mailing Address - Phone:313-701-3763
Mailing Address - Fax:
Practice Address - Street 1:1024 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1332
Practice Address - Country:US
Practice Address - Phone:313-701-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist