MEDICARE: LAURA KAY STROUD C.O.T.A.

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	235500000X	Speech/Language/Hearing Specialist/Technologist		IL

General Provider Information

NPI Number	:	1619151198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KAY STROUD C.O.T.A.

Provider Business Mailing Address
First Line	:	1003 S 23RD ST
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-4741
Country	:	US
Telephone Number	:	618-231-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 S 23RD ST
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-4741
Country	:	US
Telephone Number	:	618-231-7985
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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Directions to “ LAURA KAY STROUD C.O.T.A.” Practice Location

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