Provider Demographics
NPI:1881188225
Name:DADISHO, LAUREN (AUD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:DADISHO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:KASSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR RM 2017
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1096
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3290
Practice Address - Street 1:5333 MCAULEY DR RM 2017
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-434-3200
Practice Address - Fax:734-434-3290
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000801231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000801OtherLICENSE NUMBER, BEGINNING CREDENTIALING PROCESS