Provider Demographics
NPI:1710045406
Name:LANDRY, MARGARET HOUSTON (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:HOUSTON
Last Name:LANDRY
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 1:4066 SHELBURNE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6905
Mailing Address - Country:US
Mailing Address - Phone:802-985-8211
Mailing Address - Fax:802-985-8733
Practice Address - Street 1:4066 SHELBURNE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6905
Practice Address - Country:US
Practice Address - Phone:802-985-8211
Practice Address - Fax:802-985-8733
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12051964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12051964OtherASHA CERTIFICATION