Provider Demographics
NPI:1558783753
Name:VINCENT, LAURA H (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:VINCENT
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 1:204 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2220
Mailing Address - Country:US
Mailing Address - Phone:315-559-2789
Mailing Address - Fax:
Practice Address - Street 1:621 SKYTOP RD STE 1200
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-4416
Practice Address - Country:US
Practice Address - Phone:315-443-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58022924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist