Provider Demographics
NPI:1811137920
Name:LAIDE, EILEEN MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARIE
Last Name:LAIDE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 B 133RD STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:347-246-6446
Mailing Address - Fax:718-945-0167
Practice Address - Street 1:212 B 133RD STREET
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1436
Practice Address - Country:US
Practice Address - Phone:347-246-6446
Practice Address - Fax:718-945-0167
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist