Provider Demographics
NPI:1912685819
Name:BODENSTEINER, LAUREL
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:BODENSTEINER
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 1:669 CINDY LN
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2404
Mailing Address - Country:US
Mailing Address - Phone:716-913-9008
Mailing Address - Fax:
Practice Address - Street 1:30 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2234
Practice Address - Country:US
Practice Address - Phone:716-631-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033184-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist