Healthcare Provider Details

I. General information

NPI: 1548895899
Provider Name (Legal Business Name): MIKAYLA ADELE LAPORTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 TWO CREEK WAY APT 304
CANDLER NC
28715-1380
US

IV. Provider business mailing address

146 TWO CREEK WAY APT 304
CANDLER NC
28715-1380
US

V. Phone/Fax

Practice location:
  • Phone: 518-542-3551
  • Fax:
Mailing address:
  • Phone: 518-542-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012068
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: