Provider Demographics
NPI:1952555138
Name:KANZER, LAURIE (MS, SLP, CCC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KANZER
Suffix:
Gender:F
Credentials:MS, SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BIRCHWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2206
Mailing Address - Country:US
Mailing Address - Phone:516-465-3482
Mailing Address - Fax:516-465-3482
Practice Address - Street 1:3636 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-5112
Practice Address - Country:US
Practice Address - Phone:718-361-7464
Practice Address - Fax:718-361-7464
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist