Provider Demographics
NPI:1316947252
Name:MICHIE, LAURA (SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MICHIE
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 1:10 N JEFFERSON ST
Mailing Address - Street 2:STE 304
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4866
Mailing Address - Country:US
Mailing Address - Phone:301-471-3169
Mailing Address - Fax:
Practice Address - Street 1:10 N JEFFERSON ST
Practice Address - Street 2:STE 304
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4866
Practice Address - Country:US
Practice Address - Phone:301-668-1852
Practice Address - Fax:301-668-1854
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5060511OtherAETNA NON HMO
MD510BDO-81032101OtherCAREFIRST BLUECROSS
273799OtherMAMSI
DCT615-0005OtherCAREFIRST BLUECHOICE
216682996OtherTRICARE
2118118OtherAETNA HMO
MD216588Medicare ID - Type UnspecifiedMEDICARE MARYLAND