Provider Demographics
NPI:1780192864
Name:ALSOT, LAUREN MARY (MHS)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARY
Last Name:ALSOT
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5720
Mailing Address - Country:US
Mailing Address - Phone:815-385-7210
Mailing Address - Fax:815-344-7121
Practice Address - Street 1:701 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5517
Practice Address - Country:US
Practice Address - Phone:815-385-3123
Practice Address - Fax:815-363-5025
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL140.005547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty