Provider Demographics
NPI:1396990339
Name:QUINN, LAURA ELLEN (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LEGEND LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6316
Mailing Address - Country:US
Mailing Address - Phone:516-326-5617
Mailing Address - Fax:
Practice Address - Street 1:26 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1703
Practice Address - Country:US
Practice Address - Phone:646-826-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist