Provider Demographics
NPI:1174015531
Name:ROSENBLUM, LAUREN (CCC-SLP, TSSLD, SMHS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD, SMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2911
Mailing Address - Country:US
Mailing Address - Phone:203-984-7313
Mailing Address - Fax:
Practice Address - Street 1:20 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883-2911
Practice Address - Country:US
Practice Address - Phone:203-984-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY029504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist