Provider Demographics
NPI:1841443694
Name:LAZARUS, HEIDI SUZANNE (MS, CCC-SLP, TSHH)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:SUZANNE
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 JUDITH ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2456
Mailing Address - Country:US
Mailing Address - Phone:845-623-3258
Mailing Address - Fax:
Practice Address - Street 1:45 JUDITH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2456
Practice Address - Country:US
Practice Address - Phone:914-420-9378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010122-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist