Provider Demographics
NPI:1689818551
Name:DEVINE, LAURIE A (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:DEVINE
Suffix:
Gender:F
Credentials: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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12786-0014
Mailing Address - Country:US
Mailing Address - Phone:845-701-0954
Mailing Address - Fax:978-268-7142
Practice Address - Street 1:67 OXFORD DR.
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:NY
Practice Address - Zip Code:12786-0014
Practice Address - Country:US
Practice Address - Phone:845-701-0954
Practice Address - Fax:978-268-7142
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010532-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist