| Doctor Name: | MRS. LAURA JEAN ELLIS |
| NPI Number: | 1669888715 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 11005 |
| Business Practice Address: | 280 Pinehurst Ave Suite 6 Southern Pines, NC - 283876350 |
| Business Phone Number: | 9012468335 |
| Business Fax Number: | |
| Mailing Address: | 2401 Robeson St, FAYETTEVILLE |
| State: | NC |
| Postal Code: | 283055549 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/09/2014 |
| NPI Last Update Date: | 07/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 11005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |