Provider Demographics
NPI:1568718419
Name:ACOSTA, LAUREN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LESENDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:14291 SW 120TH ST
Mailing Address - Street 2:#103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7286
Mailing Address - Country:US
Mailing Address - Phone:786-208-2814
Mailing Address - Fax:
Practice Address - Street 1:14291 SW 120TH ST
Practice Address - Street 2:#103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7286
Practice Address - Country:US
Practice Address - Phone:786-208-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006374700Medicaid