MEDICARE: ANDREA ELAINE LASKER 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	012018	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012018	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1356650113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA ELAINE LASKER CCC-SLP

Provider Business Mailing Address
First Line	:	74 INDIAN HILL RD
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3827
Country	:	US
Telephone Number	:	914-241-0953
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 INDIAN HILL RD
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3827
Country	:	US
Telephone Number	:	914-241-0953
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “ ANDREA ELAINE LASKER CCC-SLP” Practice Location

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