Healthcare Provider Details

I. General information

NPI: 1518891050
Provider Name (Legal Business Name): LAURA TOERCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH AVE
CRIVITZ WI
54114-1674
US

IV. Provider business mailing address

N8356 LOUISA RD
CRIVITZ WI
54114-8603
US

V. Phone/Fax

Practice location:
  • Phone: 715-854-2721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590017745
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: