Healthcare Provider Details

I. General information

NPI: 1033375373
Provider Name (Legal Business Name): LAURA ANN DEWAARD MS/CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 LORNA RD SUITE 220
BIRMINGHAM AL
35216-4514
US

IV. Provider business mailing address

5912 WATERSCAPE PASS
HOOVER AL
35244-5118
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-9939
  • Fax:
Mailing address:
  • Phone: 205-901-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2542
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: