Provider Demographics
NPI:1114415239
Name:LAZOURENKO, SVETLANA (CCC- SLP)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:LAZOURENKO
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 1:1245 AVENUE X APT M1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4253
Mailing Address - Country:US
Mailing Address - Phone:718-696-9531
Mailing Address - Fax:718-509-4910
Practice Address - Street 1:2955 BRIGHTON 4TH ST # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8533
Practice Address - Country:US
Practice Address - Phone:718-509-4909
Practice Address - Fax:718-509-4910
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027330-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist