Provider Demographics
NPI:1306137732
Name:DEAL, LAURA WILLING (MCD,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:WILLING
Last Name:DEAL
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5381
Mailing Address - Country:US
Mailing Address - Phone:803-215-7498
Mailing Address - Fax:
Practice Address - Street 1:11 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5381
Practice Address - Country:US
Practice Address - Phone:803-215-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist