Provider Demographics
NPI:1750529947
Name:GERSON, LAURI DEBRA (MA/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:DEBRA
Last Name:GERSON
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 1:335 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1143
Mailing Address - Country:US
Mailing Address - Phone:631-589-8060
Mailing Address - Fax:
Practice Address - Street 1:29 LESLIE LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2318
Practice Address - Country:US
Practice Address - Phone:516-991-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003066-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist