Provider Demographics
NPI:1982367397
Name:CORTEZ, LAURA ASHLEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:CORTEZ
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 1:2427 SCHLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4374
Mailing Address - Country:US
Mailing Address - Phone:956-543-1869
Mailing Address - Fax:
Practice Address - Street 1:123 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8619
Practice Address - Country:US
Practice Address - Phone:253-848-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WALL61224623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist