Healthcare Provider Details

I. General information

NPI: 1861944027
Provider Name (Legal Business Name): LAURA PHILLIPS M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA FLYNN

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 COUNTRY CLUB DR
BUENA PARK CA
90621-1529
US

IV. Provider business mailing address

6885 ORANGETHORPE AVE
BUENA PARK CA
90620-1398
US

V. Phone/Fax

Practice location:
  • Phone: 714-523-1160
  • Fax:
Mailing address:
  • Phone: 714-522-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: