Provider Demographics
NPI:1225130289
Name:PATCHEN, LAURA G (MS, CCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:PATCHEN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2410
Mailing Address - Country:US
Mailing Address - Phone:585-385-0419
Mailing Address - Fax:585-385-0419
Practice Address - Street 1:29 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2410
Practice Address - Country:US
Practice Address - Phone:585-385-0419
Practice Address - Fax:585-385-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist