Individual
LAURA JEEP DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
Contact information
Practice address
312 SOLLEY DR, BALLWIN, MO 63021-5248
(636) 391-0666
Mailing address
6809 ARTHUR AVE, SAINT LOUIS, MO 63139-2213
(314) 402-6213
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
188
NE
235Z00000X
Speech-Language Pathologist
Primary
2009030845
MO
Other
Enumeration date
07/07/2008
Last updated
02/15/2013
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