Provider Demographics
NPI:1518110766
Name:BERUBE, LAURA A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:BERUBE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 PEGASUS CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-9504
Mailing Address - Country:US
Mailing Address - Phone:315-663-6439
Mailing Address - Fax:
Practice Address - Street 1:9 N CHAPPELL ST
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:NY
Practice Address - Zip Code:13080-9431
Practice Address - Country:US
Practice Address - Phone:315-689-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58013770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist