Provider Demographics
NPI:1003354564
Name:WEISSMAN, LAURE M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURE
Middle Name:M
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BABBLING BROOK RUN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-3008
Mailing Address - Country:US
Mailing Address - Phone:352-895-3522
Mailing Address - Fax:
Practice Address - Street 1:126 BABBLING BROOK RUN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-3008
Practice Address - Country:US
Practice Address - Phone:352-895-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist