MEDICARE: MRS. LAURA ELIZABETH BAUKOL M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1225340409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ELIZABETH BAUKOL M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	3165 INGALLS STREET
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80214
Country	:	US
Telephone Number	:	317-250-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 18TH STREET
Second Line	:	SUITE 150A
City	:	DENVER
State	:	CO
Zip	:	80211
Country	:	US
Telephone Number	:	303-433-0852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2010
Last Update Date	:	07/16/2014

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