Provider Demographics
NPI:1073895298
Name:TERRY, LAURIE-MARIE MARGARET (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE-MARIE
Middle Name:MARGARET
Last Name:TERRY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:LAURIE-MARIE
Other - Middle Name:MARGARET
Other - Last Name:PEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1222
Mailing Address - Country:US
Mailing Address - Phone:518-331-7008
Mailing Address - Fax:
Practice Address - Street 1:55 BRANDT PL
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3200
Practice Address - Country:US
Practice Address - Phone:518-843-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014943-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist