Provider Demographics
NPI:1053692863
Name:WHALEY, LAURA MARIE (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:WHALEY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:2357 LOCH BRAEMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236
Mailing Address - Country:US
Mailing Address - Phone:304-419-0500
Mailing Address - Fax:
Practice Address - Street 1:6800 LUCY CORR BLVD.
Practice Address - Street 2:ATTN: REHAB DEPT.
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23823
Practice Address - Country:US
Practice Address - Phone:804-748-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1270235Z00000X
VA2202008106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist