Active NPI
Laura A Fenn, M.A.
- Speech-Language Pathologist
- Victor, NY
National Provider Identifier
1275629503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 007958-1
- Practice address
- 590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744 - Phone
- (585) 924-7207
- Fax
- (585) 924-7049
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 007958-1 | NY | Primary |
Addresses
Primary practice location
590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744
Mailing address
590 Fishers Station Dr
Suite 130
Victor, NY 14564-9744
Phone (585) 924-7207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30-0213081 | Other | NY | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007958-1 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western New York Speech-Language Pathology, OT, and PT Consultants | Speech-Language Pathologist | Current | Accepting new patients |
Locations
590 Fishers Station Dr
Ste 130
Victor, NY 14564
Phone (585) 924-7207
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Victor, NY
- NPI 1386812550
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398211200000",
"number": "1275629503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 FISHERS STATION DR",
"address_2": "SUITE 130",
"city": "VICTOR",
"state": "NY",
"postal_code": "145649744",
"telephone_number": "585-924-7207",
"fax_number": "585-924-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 FISHERS STATION DR",
"address_2": "SUITE 130",
"city": "VICTOR",
"state": "NY",
"postal_code": "145649744",
"telephone_number": "585-924-7207",
"fax_number": "585-924-7049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENN",
"first_name": "LAURA",
"middle_name": "A",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2014-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "007958-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "30-0213081",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Victor, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.