Provider Demographics
NPI:1194003442
Name:PURDY, LAUREEN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:PURDY
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 1:104 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1228
Mailing Address - Country:US
Mailing Address - Phone:570-524-6060
Mailing Address - Fax:570-524-6061
Practice Address - Street 1:104 N 16TH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1228
Practice Address - Country:US
Practice Address - Phone:570-524-6060
Practice Address - Fax:570-524-6061
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist