Provider Demographics
NPI:1497130330
Name:EGGERTH, LAUREN W (PSYD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:W
Last Name:EGGERTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:WIDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11059 E BETHANY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2617
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2622
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2365
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical