Provider Demographics
NPI:1366486169
Name:CHURCH, LAURA MICHELE (AUD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MICHELE
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:954 THORNDALE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5828
Mailing Address - Country:US
Mailing Address - Phone:937-371-6084
Mailing Address - Fax:
Practice Address - Street 1:2216 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1370
Practice Address - Country:US
Practice Address - Phone:937-222-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01213231HA2400X, 231HA2500X, 237600000X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRA0889883Medicare ID - Type Unspecified