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General NPI Number Information
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NPI Number | 1588138630
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Entity Type | Individual
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Provider Name | LAURIER KINNEY M.S, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 5980 RADIO STATION RD
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City | LA PLATA
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State | MD
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Zip | 20646-3337
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Country | US
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Telephone | 908-868-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 N PIERCE ST APT 709
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City | ARLINGTON
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State | VA
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Zip | 22209-2852
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Country | US
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Telephone | 908-868-7190
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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 | 08513
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License Number State | MD
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