Provider Demographics
NPI:1386076651
Name:BUFORD, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9873 LAWRENCE RD
Mailing Address - Street 2:H 207
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3801
Mailing Address - Country:US
Mailing Address - Phone:570-932-1283
Mailing Address - Fax:
Practice Address - Street 1:5605 PACIFIC BLVD
Practice Address - Street 2:3202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3801
Practice Address - Country:US
Practice Address - Phone:570-932-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist