Provider Demographics
NPI:1295454700
Name:HIGGINS, LAUREN ELISE PETERSON (MS, BC-DMT)
Entity type:Individual
Prefix:MS
First Name:LAUREN ELISE
Middle Name:PETERSON
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MS, BC-DMT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELISE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BC-DMT
Mailing Address - Street 1:4906 SAINT ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1726
Mailing Address - Country:US
Mailing Address - Phone:423-653-4478
Mailing Address - Fax:
Practice Address - Street 1:4906 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1726
Practice Address - Country:US
Practice Address - Phone:423-653-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist