Provider Demographics
NPI:1194811695
Name:LAFFY, GLENN J (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:J
Last Name:LAFFY
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11348 N FORDYCE
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622
Mailing Address - Country:US
Mailing Address - Phone:989-588-4474
Mailing Address - Fax:
Practice Address - Street 1:11348 N FORDYCE
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622
Practice Address - Country:US
Practice Address - Phone:989-588-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7101002554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist