Provider Demographics
NPI:1316401060
Name:WALKER, LAUREN DESERET (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DESERET
Last Name:WALKER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5273
Mailing Address - Country:US
Mailing Address - Phone:513-290-8684
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3600
Practice Address - Country:US
Practice Address - Phone:513-290-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1736371744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management