Provider Demographics
NPI:1356913784
Name:NAZAIRE, LAURIE V (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:V
Last Name:NAZAIRE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LOCUSTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2009
Mailing Address - Country:US
Mailing Address - Phone:347-279-4967
Mailing Address - Fax:
Practice Address - Street 1:16701 GOTHIC DR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1935
Practice Address - Country:US
Practice Address - Phone:718-558-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03247901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist