Provider Demographics
NPI:1447357801
Name:POLICH, LAURA G (PHD, CCC-A & SLP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:G
Last Name:POLICH
Suffix:
Gender:F
Credentials:PHD, CCC-A & SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NE 20TH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2275
Mailing Address - Country:US
Mailing Address - Phone:503-806-1498
Mailing Address - Fax:503-805-5244
Practice Address - Street 1:825 NE 20TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2275
Practice Address - Country:US
Practice Address - Phone:503-806-1498
Practice Address - Fax:503-805-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22898231H00000X
WALD00004694231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist