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Individual

MRS. LAURIE ANGELA SOUTHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1413 LASKIN RD, VIRGINIA BEACH, VA 23451-6007
(757) 263-2800
Mailing address
2400 BRASILENO DR, VIRGINIA BEACH, VA 23456-6436
(757) 721-2227

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202001863
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2202001863
VA DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
03/08/2018
Last updated
03/08/2018
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