MEDICARE: MRS. LAURIE FULTON GODFREY M.S., 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	6426	NC

General Provider Information

NPI Number	:	1376694653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE FULTON GODFREY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	924 NORTHBROOK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5518
Country	:	US
Telephone Number	:	919-219-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 W WILLIAMS ST
Second Line	:	SUITE 104
City	:	APEX
State	:	NC
Zip	:	27502-3955
Country	:	US
Telephone Number	:	919-363-5000
Fax Number	:

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. LAURIE FULTON GODFREY M.S., CCC-SLP” Practice Location

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