Provider Demographics
NPI:1447604418
Name:CULLEN, LAURA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CULLEN
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 1:852 N LEAVITT ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:852 N LEAVITT ST
Practice Address - Street 2:APT. 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4805
Practice Address - Country:US
Practice Address - Phone:708-228-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist