Provider Demographics
NPI:1780215921
Name:ALLEN, LAURA JEAN (MS, CCC,SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 SEELEY RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13470-2311
Mailing Address - Country:US
Mailing Address - Phone:507-340-5249
Mailing Address - Fax:
Practice Address - Street 1:338 SEELEY RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NY
Practice Address - Zip Code:13470-2311
Practice Address - Country:US
Practice Address - Phone:518-212-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
NY034909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist