=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346069481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENT LANGUAGE LAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 W CHESTER PIKE STE 200
-----------------------------------------------------
City | UPPER DARBY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19082-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-634-3191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 ACADEMY LN
-----------------------------------------------------
City | UPPER DARBY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19082-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-693-8148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH THERAPIST
-----------------------------------------------------
Name | LINDSLAY LAURENT
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 267-693-8148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------