1073895298 NPI number — MRS. LAURIE-MARIE MARGARET TERRY MS CCC-SLP

Table of content: MRS. LAURIE-MARIE MARGARET TERRY MS CCC-SLP (NPI 1073895298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073895298 NPI number — MRS. LAURIE-MARIE MARGARET TERRY MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
LAURIE-MARIE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEIFER
Provider Other First Name:
LAURIE-MARIE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073895298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 GEORGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-331-7008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 BRANDT PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-843-3716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  014943-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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