MEDICARE: MRS. LAURA BABETTE WARDLAW MS.CCC-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	231H00000X	Audiologist	#236	AR

General Provider Information

NPI Number	:	1861529950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA BABETTE WARDLAW MS.CCC-A

Provider Business Mailing Address
First Line	:	PO BOX 7697
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72217-7697
Country	:	US
Telephone Number	:	501-529-4094
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 RIVER RIDGE RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-1525
Country	:	US
Telephone Number	:	501-529-4094
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/09/2007

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