Provider Demographics
NPI:1205985306
Name:LAUER, DARRELL LYNN (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:LYNN
Last Name:LAUER
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:305 RIVERSIDE DR
Mailing Address - Street 2:APT. 12A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5286
Mailing Address - Country:US
Mailing Address - Phone:212-865-7439
Mailing Address - Fax:212-866-1754
Practice Address - Street 1:305 RIVERSIDE DR
Practice Address - Street 2:APT. 12A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5286
Practice Address - Country:US
Practice Address - Phone:212-865-7439
Practice Address - Fax:212-866-1754
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009044-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist