Provider Demographics
NPI:1366129496
Name:LAFOUNTAIN, ARLEIGH MARIE
Entity type:Individual
Prefix:
First Name:ARLEIGH
Middle Name:MARIE
Last Name:LAFOUNTAIN
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 1:16 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROUSES POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12979-1632
Mailing Address - Country:US
Mailing Address - Phone:518-944-9564
Mailing Address - Fax:
Practice Address - Street 1:5572 RT. 11
Practice Address - Street 2:
Practice Address - City:ELLENBURG CENTER
Practice Address - State:NY
Practice Address - Zip Code:12934
Practice Address - Country:US
Practice Address - Phone:518-594-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY034512-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program