Healthcare Provider Details

I. General information

NPI: 1861328775
Provider Name (Legal Business Name): LAURA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MILITARY W
BENICIA CA
94510-2558
US

IV. Provider business mailing address

35 BUENA VIS
BENICIA CA
94510-2609
US

V. Phone/Fax

Practice location:
  • Phone: 707-747-8300
  • Fax:
Mailing address:
  • Phone: 707-747-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP20138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: