Provider Demographics
NPI:1386897361
Name:PALUMBO, LAURA ANNE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:PALUMBO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EAGLE TRCE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1506
Mailing Address - Country:US
Mailing Address - Phone:518-877-0997
Mailing Address - Fax:
Practice Address - Street 1:12 EAGLE TRCE
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1506
Practice Address - Country:US
Practice Address - Phone:518-877-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007640-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist