Provider Demographics
NPI:1487900932
Name:BARRETT, LAURA BETH (SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:BARRETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:SUGARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14012 RORA MOSS PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2648
Mailing Address - Country:US
Mailing Address - Phone:703-864-6652
Mailing Address - Fax:
Practice Address - Street 1:14012 RORA MOSS PL
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2648
Practice Address - Country:US
Practice Address - Phone:703-864-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2202004460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004978277Medicaid