Provider Demographics
NPI:1548403983
Name:EISENGREIN, LAURA LOUISE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LOUISE
Last Name:EISENGREIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LOUISE
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1652 KELLER PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3876
Mailing Address - Country:US
Mailing Address - Phone:817-562-3111
Mailing Address - Fax:817-562-3114
Practice Address - Street 1:1652 KELLER PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:817-562-3114
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist