Provider Demographics
NPI:1316204977
Name:EYSERMANS, LAUREN R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:R
Last Name:EYSERMANS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:LAURE
Other - Middle Name:
Other - Last Name:EYSERMANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 5000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-820-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12130770OtherASHA MEMBERSHIP NUMBER
TX105972OtherSLP LICENSE