MEDICARE: LAURA LEE SERRIANNE M.A.C.C.C.-S.L.P.

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	0140112-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	014012-1	OTHER	NY	NYS LISCENCE FOR SPEECH/LANGUAGE PATHOLOGY

General Provider Information

NPI Number	:	1598913998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEE SERRIANNE M.A.C.C.C.-S.L.P.

Provider Business Mailing Address
First Line	:	8831 POINT AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4456
Country	:	US
Telephone Number	:	716-283-0610
Fax Number	:

Provider Business Practice Location Address
First Line	:	8831 POINT AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4456
Country	:	US
Telephone Number	:	716-283-0610
Fax Number	:

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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