Provider Demographics
NPI:1821531773
Name:BENDIKSEN, LAURA JEANNE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:BENDIKSEN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2438
Mailing Address - Country:US
Mailing Address - Phone:413-788-6648
Mailing Address - Fax:
Practice Address - Street 1:30 OLD LYMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2630
Practice Address - Country:US
Practice Address - Phone:413-533-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist