Provider Demographics
NPI:1194695346
Name:REDWINE, LAURA (MS CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:REDWINE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 STRATTON DR APT 16317
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5366
Mailing Address - Country:US
Mailing Address - Phone:214-207-9298
Mailing Address - Fax:
Practice Address - Street 1:9440 STRATTON DR APT 16317
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5366
Practice Address - Country:US
Practice Address - Phone:214-207-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist