Healthcare Provider Details

I. General information

NPI: 1306983416
Provider Name (Legal Business Name): ELIZABETH ANNE LACZI RSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST WYOMING COUNTY COMMUNITY HOSPITAL
WARSAW NY
14569-1025
US

IV. Provider business mailing address

480 ASHLAND AVE
BUFFALO NY
14222-1502
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2233
  • Fax: 585-786-1268
Mailing address:
  • Phone: 716-213-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number015121-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: