Provider Demographics
NPI:1245594035
Name:PELLETIER, LAUREN WHITNEY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:WHITNEY
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 SUMMER GLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4462
Mailing Address - Country:US
Mailing Address - Phone:702-629-9022
Mailing Address - Fax:
Practice Address - Street 1:1454 SUMMER GLOW AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4462
Practice Address - Country:US
Practice Address - Phone:702-629-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1702789662225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner