Provider Demographics
NPI:1083916886
Name:SURDAK-UPRIGHT, LAURIE (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:SURDAK-UPRIGHT
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 1:1180 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5251
Mailing Address - Country:US
Mailing Address - Phone:585-262-8888
Mailing Address - Fax:
Practice Address - Street 1:1180 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5251
Practice Address - Country:US
Practice Address - Phone:585-262-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007456-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist