Doctor Name: | MRS. LAURIE MICHELLE BOHANNON |
NPI Number: | 1699196402 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 11950 |
Business Practice Address: | 41951 Moraga Rd Temecula, CA - 925914742 |
Business Phone Number: | 9516957130 |
Business Fax Number: | |
Mailing Address: | 43871 Via Montalban, TEMECULA |
State: | CA |
Postal Code: | 925923983 |
Phone Number: | 9099648086 |
Fax Number: | |
NPI Enumeration Date: | 12/20/2013 |
NPI Last Update Date: | 12/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 11950 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
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 |