MEDICARE: GLENN J LAFFY CCC-SLP

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
2	235Z00000X	Speech-Language Pathologist	7101002554	MI

General Provider Information

NPI Number	:	1194811695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN J LAFFY CCC-SLP

Provider Business Mailing Address
First Line	:	11348 N FORDYCE
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622
Country	:	US
Telephone Number	:	989-588-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	11348 N FORDYCE
Second Line	:
City	:	FARWELL
State	:	MI
Zip	:	48622
Country	:	US
Telephone Number	:	989-588-4474
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/28/2023

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Directions to “ GLENN J LAFFY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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