Provider Demographics
NPI:1407623606
Name:ITZLER, LAUREN ELISSA
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISSA
Last Name:ITZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 ELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4803
Mailing Address - Country:US
Mailing Address - Phone:631-942-0323
Mailing Address - Fax:
Practice Address - Street 1:283 COMMACK RD STE 303
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-942-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist