Provider Demographics
NPI:1346545324
Name:SNOW, LAURA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:SNOW
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 1:18564 US ROUTE 11
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5900
Mailing Address - Country:US
Mailing Address - Phone:315-786-7202
Mailing Address - Fax:315-786-1524
Practice Address - Street 1:18564 US ROUTE 11
Practice Address - Street 2:SUITE 5
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5900
Practice Address - Country:US
Practice Address - Phone:315-786-7202
Practice Address - Fax:315-786-1524
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007143-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist