Provider Demographics
NPI:1922383033
Name:SANDERS, LAUREN C
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:C
Last Name:SANDERS
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 1:1632 BOGART AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4004
Mailing Address - Country:US
Mailing Address - Phone:646-645-6929
Mailing Address - Fax:347-621-5048
Practice Address - Street 1:1632 BOGART AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4004
Practice Address - Country:US
Practice Address - Phone:646-645-6929
Practice Address - Fax:347-621-5048
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist