Provider Demographics
NPI:1700041704
Name:WASSERMAN, LOU ANN (MS - SLP)
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MS - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4456
Mailing Address - Country:US
Mailing Address - Phone:954-968-8333
Mailing Address - Fax:
Practice Address - Street 1:4125 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4456
Practice Address - Country:US
Practice Address - Phone:954-968-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist