Provider Demographics
NPI:1174876338
Name:BIRTZ-SISSON, LAURA A (TSHH, MS ED)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:BIRTZ-SISSON
Suffix:
Gender:F
Credentials:TSHH, MS ED
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:BIRTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:ROUSES POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12979-1023
Mailing Address - Country:US
Mailing Address - Phone:518-297-3732
Mailing Address - Fax:
Practice Address - Street 1:39 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:ROUSES POINT
Practice Address - State:NY
Practice Address - Zip Code:12979-1023
Practice Address - Country:US
Practice Address - Phone:518-297-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1843288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist