Provider Demographics
NPI:1184939779
Name:REITSMA, LAUREN PATRICE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:PATRICE
Last Name:REITSMA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:PATRICE
Other - Last Name:MELLUSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7400 RIVER RD.
Mailing Address - Street 2:APT. 108
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047
Mailing Address - Country:US
Mailing Address - Phone:917-442-4002
Mailing Address - Fax:
Practice Address - Street 1:3085 TIERNEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-4059
Practice Address - Country:US
Practice Address - Phone:718-792-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03893212Medicaid