Basic Information
Provider Information
NPI: 1619321833
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYE
FirstName: LAURA
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: MS, CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 CROSS ST
Address2:  
City: BIG STONE CITY
State: SD
PostalCode: 572168237
CountryCode: US
TelephoneNumber: 6055411140
FaxNumber: 6055410109
Practice Location
Address1: 15620 EDGEWOOD DR STE 240
Address2:  
City: BAXTER
State: MN
PostalCode: 564016984
CountryCode: US
TelephoneNumber: 2184547012
FaxNumber: 2184547015
Other Information
ProviderEnumerationDate: 04/14/2016
LastUpdateDate: 03/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X8751MNY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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