Provider Demographics
NPI:1164868196
Name:ROSSON, LAUREN (SLP-A)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROSSON
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WOODBERRY
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-3926
Mailing Address - Country:US
Mailing Address - Phone:870-224-3585
Mailing Address - Fax:
Practice Address - Street 1:113 WOODBERRY
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-3926
Practice Address - Country:US
Practice Address - Phone:870-224-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSLP-A FOR SP#23752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196551721Medicaid