Healthcare Provider Details

I. General information

NPI: 1881446714
Provider Name (Legal Business Name): LAZOURENKO SPEECH SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 AVENUE X APT M1
BROOKLYN NY
11235-4253
US

IV. Provider business mailing address

1245 AVENUE X APT M1
BROOKLYN NY
11235-4253
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-9531
  • Fax:
Mailing address:
  • Phone: 718-696-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SVETLANA LAZOURENKO
Title or Position: SPEECH THERAPIST
Credential: M.S. CCC-SLP
Phone: 718-696-9531