Provider Demographics
NPI:1588785802
Name:DONOGHUE, LAURA ELLEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11060 HI TECH DR
Practice Address - Street 2:LEAPS AND BOUNDS THERAPY SERVICES
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9133
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:734-449-4669
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist