Individual provider Active NPI

Laura A Fenn, M.A.

  • Speech-Language Pathologist
  • Victor, NY
National Provider Identifier
1275629503
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
007958-1 Issued in NY
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

Updated by the provider on Apr 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
30-0213081OtherNYTAX 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

LicenseStateTypeSpecialty
007958-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.