Provider Demographics
NPI:1386068880
Name:SMITH, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7011
Mailing Address - Country:US
Mailing Address - Phone:330-965-7828
Mailing Address - Fax:330-965-7901
Practice Address - Street 1:506 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-1151
Practice Address - Country:US
Practice Address - Phone:330-938-2025
Practice Address - Fax:330-938-2686
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist