MEDICARE: MRS. LAURA L GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2679	TN
2	235Z00000X	Speech-Language Pathologist	S-5282	MS

General Provider Information

NPI Number	:	1528241783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA L GREEN

Provider Business Mailing Address
First Line	:	5425 EVENING MIST DR
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-5016
Country	:	US
Telephone Number	:	901-230-2926
Fax Number	:

Provider Business Practice Location Address
First Line	:	5425 EVENING MIST DR
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-5016
Country	:	US
Telephone Number	:	901-230-2926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	01/15/2026

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Directions to “ MRS. LAURA L GREEN ” Practice Location

Language	Start Address	Practice Location

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