MEDICARE: LAURIE KANZER M.S., SLP, CCC

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	013636	NY

General Provider Information

NPI Number	:	1952555138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE KANZER M.S., SLP, CCC

Provider Business Mailing Address
First Line	:	110 BIRCHWOOD PARK DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2206
Country	:	US
Telephone Number	:	516-465-3482
Fax Number	:	516-465-3482

Provider Business Practice Location Address
First Line	:	3636 10TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-5112
Country	:	US
Telephone Number	:	718-361-7464
Fax Number	:	718-361-7464

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/29/2016

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