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General NPI Number Information
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NPI Number | 1134319114
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Entity Type | Individual
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Provider Name | MRS. LAURA DEROCHE
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 150 NEW PROVIDENCE RD
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2590
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Country | US
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Telephone | 908-233-3720
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Fax |
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Provider Business Mailing Address
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Address Line | 23 JOHN DR
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City | ANNANDALE
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State | NJ
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Zip | 08801-3009
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Country | US
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Telephone | 973-752-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00543700
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License Number State | NJ
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