Basic Information
| Provider Information | |||||||||
| NPI: | 1801045166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIROUARD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 N LOGAN ST C/O REHAB-SPEECH PATHOLOGY | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174435276 | ||||||||
| FaxNumber: | 2174435634 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 S OAK ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618200906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173332205 | ||||||||
| FaxNumber: | 2173332206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.008811 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.