Provider Demographics
NPI:1073171955
Name:HAZELET, LAURYN
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:HAZELET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-2208
Mailing Address - Country:US
Mailing Address - Phone:432-559-1165
Mailing Address - Fax:
Practice Address - Street 1:8001 S US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5707
Practice Address - Country:US
Practice Address - Phone:806-744-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant