MEDICARE: LAURA PRINCE

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	3981-154	WI

General Provider Information

NPI Number	:	1790161412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PRINCE

Provider Business Mailing Address
First Line	:	100 GLENOAKS DR
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9580
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 GLENOAKS DR
Second Line	:
City	:	NEW LONDON
State	:	MN
Zip	:	56273-9580
Country	:	US
Telephone Number	:	320-354-2231
Fax Number	:

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	05/03/2023

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Directions to “ LAURA PRINCE ” Practice Location

Language	Start Address	Practice Location

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