Provider Demographics
NPI:1417233172
Name:PECONIE, LAURIE NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:NICOLE
Last Name:PECONIE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 STUYVESANT ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5525
Mailing Address - Country:US
Mailing Address - Phone:518-506-4344
Mailing Address - Fax:
Practice Address - Street 1:108 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-1238
Practice Address - Country:US
Practice Address - Phone:518-370-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015714235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist