Provider Demographics
NPI:1225345705
Name:CAVANAGH, LAURIE A (MS ED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:A
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:MS ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5944
Mailing Address - Country:US
Mailing Address - Phone:716-433-1982
Mailing Address - Fax:
Practice Address - Street 1:124 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5944
Practice Address - Country:US
Practice Address - Phone:716-433-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist