Provider Demographics
NPI:1063739878
Name:BROCKHUES, LAURA KATHERINE (MA, SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHERINE
Last Name:BROCKHUES
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1152
Mailing Address - Country:US
Mailing Address - Phone:518-578-0868
Mailing Address - Fax:
Practice Address - Street 1:185 MARGARET ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1837
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist