Provider Demographics
NPI:1811207921
Name:MCNICHOLAS, LAURA KATERYNA (MA CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATERYNA
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:KATERYNA
Other - Last Name:SEMKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP, TSSLD
Mailing Address - Street 1:91 STRAWBERRY HILL AVE
Mailing Address - Street 2:APT 428
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2762
Mailing Address - Country:US
Mailing Address - Phone:203-569-0050
Mailing Address - Fax:
Practice Address - Street 1:5 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2135
Practice Address - Country:US
Practice Address - Phone:914-592-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019209-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist