Provider Demographics
NPI:1578699567
Name:LAURSEN, CHARLENE ANN (MS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 CLARENDON LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3263
Mailing Address - Country:US
Mailing Address - Phone:630-305-0593
Mailing Address - Fax:630-305-0683
Practice Address - Street 1:932 N WRIGHT ST STE 128
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3601
Practice Address - Country:US
Practice Address - Phone:630-305-0593
Practice Address - Fax:630-305-0683
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist