Provider Demographics
NPI:1750565669
Name:KISVER, LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KISVER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALNUT ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3562
Mailing Address - Country:US
Mailing Address - Phone:617-771-7520
Mailing Address - Fax:
Practice Address - Street 1:12 WALNUT ST
Practice Address - Street 2:UNIT 7
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3562
Practice Address - Country:US
Practice Address - Phone:617-771-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist