MEDICARE: LAURA NICOLE XIAO MA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	235Z00000X	Speech-Language Pathologist	0003821	CO

General Provider Information

NPI Number	:	1891261707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA NICOLE XIAO MA

Provider Business Mailing Address
First Line	:	1495 MADISON RIDGE HTS APT C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2733
Country	:	US
Telephone Number	:	631-848-5713
Fax Number	:

Provider Business Practice Location Address
First Line	:	7092 HARR AVE BLDG 6492
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80902-2190
Country	:	US
Telephone Number	:	719-524-5218
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	11/27/2023

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