Provider Demographics
NPI:1679711964
Name:LAUDADIO, LISETTE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:MARIE
Last Name:LAUDADIO
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 1:216 BAY 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5823
Mailing Address - Country:US
Mailing Address - Phone:718-331-7390
Mailing Address - Fax:
Practice Address - Street 1:216 BAY 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5823
Practice Address - Country:US
Practice Address - Phone:718-331-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist