Provider Demographics
NPI:1841354644
Name:BORNSTEIN, LAURIE KAY (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:KAY
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5068 W PLANO PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4408
Mailing Address - Country:US
Mailing Address - Phone:972-447-8330
Mailing Address - Fax:972-381-4201
Practice Address - Street 1:5068 W PLANO PKWY
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4408
Practice Address - Country:US
Practice Address - Phone:972-447-8330
Practice Address - Fax:972-381-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51344231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528417OtherBLUE CROSS BLUE SHIELD
TX528417OtherBLUE CROSS BLUE SHIELD