| Doctor Name: | MRS. LAURA M CHIDESTER |
| NPI Number: | 1487850855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SPEECH PATHOLOGIST |
| License Number: | 016374-1 |
| Business Practice Address: | 87 Ellis Creek Rd Waverly, NY - 148929540 |
| Business Phone Number: | 6079725158 |
| Business Fax Number: | 6079484097 |
| Mailing Address: | 3012 Robins St, ENDWELL |
| State: | NY |
| Postal Code: | 137603430 |
| Phone Number: | 6073486898 |
| Fax Number: | 6079484097 |
| NPI Enumeration Date: | 06/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 016374-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |