Healthcare Provider Details

I. General information

NPI: 1871690123
Provider Name (Legal Business Name): LAURA BETH WOODRING M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HARVEST LN.
MT. WASHINGTON KY
40047-5813
US

IV. Provider business mailing address

121 HARVEST LANE
MOUNT WASHINGTON KY
40047
US

V. Phone/Fax

Practice location:
  • Phone: 502-432-0782
  • Fax: 502-538-8213
Mailing address:
  • Phone: 502-432-0782
  • Fax: 504-538-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2583
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: