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General NPI Number Information
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NPI Number | 1811207921
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Entity Type | Individual
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Provider Name | LAURA KATERYNA MCNICHOLAS M.A. CCC-SLP, TSSLD
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Gender | Female
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 5 BRADHURST AVE
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City | HAWTHORNE
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State | NY
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Zip | 10532-2135
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Country | US
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Telephone | 914-592-8526
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Fax |
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Provider Business Mailing Address
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Address Line | 91 STRAWBERRY HILL AVE APT 428
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City | STAMFORD
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State | CT
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Zip | 06902-2762
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Country | US
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Telephone | 203-569-0050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 019209-1
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License Number State | NY
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