Provider Demographics
NPI:1437693769
Name:DUSTERWALD, LAURA MARY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:DUSTERWALD
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 1:17901 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4739
Mailing Address - Country:US
Mailing Address - Phone:718-739-0007
Mailing Address - Fax:718-480-2819
Practice Address - Street 1:17901 90TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4739
Practice Address - Country:US
Practice Address - Phone:718-739-0007
Practice Address - Fax:718-480-2819
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist