Provider Demographics
NPI:1285937177
Name:STREEBEL, LAURIE AILEEN (MS, CCC/SLP NYS LIC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:AILEEN
Last Name:STREEBEL
Suffix:
Gender:F
Credentials:MS, CCC/SLP NYS LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2307
Mailing Address - Country:US
Mailing Address - Phone:716-832-0147
Mailing Address - Fax:
Practice Address - Street 1:5360 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1044
Practice Address - Country:US
Practice Address - Phone:716-783-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004602-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00170340OtherAMERICAN SPEECH-HEARING ASSOC. CLINICAL COMPETENCE
NY004602-1OtherNEW YORK STATE LICENSE SPEECH-LANGUAGE PATHOLOGIST