MEDICARE: MRS. LAURA LYNN GARRETT 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	12119434

General Provider Information

NPI Number	:	1457639940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA LYNN GARRETT CCC-SLP

Provider Business Mailing Address
First Line	:	9758 LAREDO ST
Second Line	:	UNIT 36 B
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9803
Country	:	US
Telephone Number	:	501-590-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	9758 LAREDO ST
Second Line	:	UNIT 36 B
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9803
Country	:	US
Telephone Number	:	501-590-1770
Fax Number	:

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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