Individual
LAURA LICUANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4 MILITIA DRIVE, INSTITUTE FOR LEARNING AND DEVELOPMENT, LEXINGTON, MA 02421
(864) 230-0495
Mailing address
123 TRENTON ST, APT 1, EAST BOSTON, MA 02128-2536
(864) 230-0495
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8086
MA
Other
Enumeration date
10/07/2011
Last updated
10/07/2011
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