Provider Demographics
NPI:1750852562
Name:IRONMAN, LAURA JEANNE (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEANNE
Last Name:IRONMAN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BURNS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3408
Mailing Address - Country:US
Mailing Address - Phone:631-375-8147
Mailing Address - Fax:
Practice Address - Street 1:213 BURNS CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2114
Practice Address - Country:US
Practice Address - Phone:631-375-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01788L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty