Provider Demographics
NPI:1679956478
Name:HOLT, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HOLT
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 1:300 CHURCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2253
Mailing Address - Country:US
Mailing Address - Phone:203-410-0974
Mailing Address - Fax:888-980-7890
Practice Address - Street 1:300 CHURCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2253
Practice Address - Country:US
Practice Address - Phone:203-410-0974
Practice Address - Fax:888-980-7890
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist