MEDICARE: MRS. LAURA R BACON M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0164661	NY

General Provider Information

NPI Number	:	1467605022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA R BACON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1 IRIS CIR
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3931
Country	:	US
Telephone Number	:	914-391-2094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 IRIS CIR
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-3931
Country	:	US
Telephone Number	:	914-391-2094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	03/23/2015

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Directions to “ MRS. LAURA R BACON M.S., CCC-SLP” Practice Location

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