MEDICARE: LAURA ELISABETH HORNUNG CCC-SLP

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	SL013466	PA

General Provider Information

NPI Number	:	1538707534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELISABETH HORNUNG CCC-SLP

Provider Business Mailing Address
First Line	:	1440 DICKINSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4842
Country	:	US
Telephone Number	:	610-883-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 DICKINSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4842
Country	:	US
Telephone Number	:	610-883-7877
Fax Number	:

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

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	05/11/2026

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