Provider Demographics
NPI:1548694748
Name:STIFFLER, LAURA ELAINE (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELAINE
Last Name:STIFFLER
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELAINE
Other - Last Name:SHANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6378 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7989
Mailing Address - Country:US
Mailing Address - Phone:716-579-6812
Mailing Address - Fax:
Practice Address - Street 1:6378 TONAWANDA CREEK RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-7989
Practice Address - Country:US
Practice Address - Phone:716-433-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist