Healthcare Provider Details

I. General information

NPI: 1346704269
Provider Name (Legal Business Name): LAURA DODD M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 COUNTRYBROOK LOOP
SAN RAMON CA
94583-4473
US

IV. Provider business mailing address

136 COUNTRYBROOK LOOP
SAN RAMON CA
94583-4473
US

V. Phone/Fax

Practice location:
  • Phone: 925-232-1043
  • Fax: 925-523-0903
Mailing address:
  • Phone: 559-801-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: