Laurie Jean Wennerholm, MA, CCC-SLP, BRS-S

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

011025-1 Issued in NY

Practice address

2 Longview Ave FL 6
White Plains, NY 10601-5000

Phone

(914) 849-7586

Fax

(914) 849-7958

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1619021847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 212TH ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612048",
            "telephone_number": "718-352-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 LONGVIEW AVE FL 6",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106015000",
            "telephone_number": "914-849-7586",
            "fax_number": "914-849-7958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 E Post Rd",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "NY",
            "postal_code": "106014607",
            "country_code": "US",
            "telephone_number": "914-849-7586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENNERHOLM",
        "first_name": "LAURIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "MA, CCC-SLP, BRS-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "011025-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in White Plains, NY
• Providers in White Plains, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; 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.