Provider Demographics
NPI:1205092152
Name:STITZ, LAUREN DYANN (MA)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:DYANN
Last Name:STITZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 STEED TER
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7627
Mailing Address - Country:US
Mailing Address - Phone:407-921-3538
Mailing Address - Fax:
Practice Address - Street 1:4408 STEED TER
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7627
Practice Address - Country:US
Practice Address - Phone:407-921-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4318235Z00000X
FLSA10135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205092152Medicaid