Healthcare Provider Details

I. General information

NPI: 1609768753
Provider Name (Legal Business Name): LAURA DUQUE WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14003 CLUBHOUSE CIR APT 305
TAMPA FL
33618-7507
US

IV. Provider business mailing address

14003 CLUBHOUSE CIR APT 305
TAMPA FL
33618-7507
US

V. Phone/Fax

Practice location:
  • Phone: 941-879-5586
  • Fax: 941-879-5586
Mailing address:
  • Phone: 941-879-5586
  • Fax: 941-879-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8127
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-452075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: