Provider Demographics
NPI:1730595117
Name:BLACK, LAURA ROZIER (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROZIER
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 ASHLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2441
Mailing Address - Country:US
Mailing Address - Phone:704-576-7409
Mailing Address - Fax:
Practice Address - Street 1:13316 MALLARD LANDING RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7405
Practice Address - Country:US
Practice Address - Phone:704-971-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist