Provider Demographics
NPI:1720565229
Name:WASSERBERGER, LAUREN (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WASSERBERGER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 MOUNT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6930
Mailing Address - Country:US
Mailing Address - Phone:813-480-0589
Mailing Address - Fax:
Practice Address - Street 1:850 PERRY RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7701
Practice Address - Country:US
Practice Address - Phone:813-480-0589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist