Provider Demographics
NPI:1730459744
Name:SANFILIPPO, LAURA (LICENSED SLP, MA-CCC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:LICENSED SLP, MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 WELLINGTON DR S
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9439
Mailing Address - Country:US
Mailing Address - Phone:315-655-5432
Mailing Address - Fax:
Practice Address - Street 1:1732 FYLER RD
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8522
Practice Address - Country:US
Practice Address - Phone:315-687-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0043081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01434959Medicaid