Provider Demographics
NPI:1427473032
Name:MAURILLO, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAURILLO
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 1:377 NW JASPER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1279
Mailing Address - Country:US
Mailing Address - Phone:503-623-1844
Mailing Address - Fax:
Practice Address - Street 1:1955 DALLAS HWY NW
Practice Address - Street 2:STE 1200
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4466
Practice Address - Country:US
Practice Address - Phone:503-362-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist