Provider Demographics
NPI:1124396379
Name:GUTTENBERG, LAURIE I (MA,CCC,LSP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:I
Last Name:GUTTENBERG
Suffix:
Gender:F
Credentials:MA,CCC,LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2138
Mailing Address - Country:US
Mailing Address - Phone:516-496-4660
Mailing Address - Fax:
Practice Address - Street 1:265 SPLIT ROCK RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2138
Practice Address - Country:US
Practice Address - Phone:516-496-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist