Healthcare Provider Details

I. General information

NPI: 1841456266
Provider Name (Legal Business Name): LAURIE K WHITE BEDIENT M.A., CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

PO BOX 840
JAMESTOWN NY
14702-0840
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-8194
  • Fax: 716-664-8418
Mailing address:
  • Phone: 716-664-8194
  • Fax: 716-664-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000699-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number000699-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: