Basic Information
| Provider Information | |||||||||
| NPI: | 1528646502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERROTTA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4351 CREST LINE LN | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280759514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9802970200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277054699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196846271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2021 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14717 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.