Provider Demographics
NPI:1992009740
Name:KOLIN, LAURIE DANIELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:DANIELLE
Last Name:KOLIN
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 1:225 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7433
Mailing Address - Country:US
Mailing Address - Phone:516-641-1806
Mailing Address - Fax:
Practice Address - Street 1:645 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0010
Practice Address - Country:US
Practice Address - Phone:516-641-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12147418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY932033592OtherGHI