Individual
LAURA CUSTANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
236 BALD EAGLE WAY, WILLIAMSBURG, VA 23188-4022
(202) 908-9946
Mailing address
236 BALD EAGLE WAY, WILLIAMSBURG, VA 23188-4022
(202) 908-9946
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
12372
CA
235Z00000X
Speech-Language Pathologist
Primary
2202010612
VA
Other
Enumeration date
05/09/2024
Last updated
08/05/2024
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