Provider Demographics
NPI:1467704866
Name:DERX, NOELLE LAMB (SLP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LAMB
Last Name:DERX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELM STREET
Mailing Address - Street 2:PO BOX 790
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770
Mailing Address - Country:US
Mailing Address - Phone:716-933-6045
Mailing Address - Fax:
Practice Address - Street 1:500 ELM ST
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9793
Practice Address - Country:US
Practice Address - Phone:716-933-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist