Healthcare Provider Details

I. General information

NPI: 1982496303
Provider Name (Legal Business Name): LAURA LIN COMOLLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE OFC 516
TOWSON MD
21204-4763
US

IV. Provider business mailing address

3133 WHEATLYN RD
YORK PA
17402-9569
US

V. Phone/Fax

Practice location:
  • Phone: 443-218-6007
  • Fax:
Mailing address:
  • Phone: 302-222-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12110
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: