Provider Demographics
NPI:1174759286
Name:CORCORAN, LAURA JANE (MS, CCC-SLP, LSLS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, LSLS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANE
Other - Last Name:PERLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, LSLS
Mailing Address - Street 1:10243 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2028
Mailing Address - Country:US
Mailing Address - Phone:414-604-7244
Mailing Address - Fax:414-604-7200
Practice Address - Street 1:10243 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2028
Practice Address - Country:US
Practice Address - Phone:414-604-7244
Practice Address - Fax:414-604-7200
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3230-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist