Provider Demographics
NPI:1043354384
Name:HEINLEIN, LAUREN MICHELE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELE
Last Name:HEINLEIN
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 1:221 ERIK DR
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6453
Mailing Address - Country:US
Mailing Address - Phone:631-944-1966
Mailing Address - Fax:
Practice Address - Street 1:221 ERIK DR
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6453
Practice Address - Country:US
Practice Address - Phone:631-944-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist