Healthcare Provider Details

I. General information

NPI: 1760666234
Provider Name (Legal Business Name): LAURIN B EPSTEIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E CHESTNUT BLVD
LAKE HAVASU CITY AZ
86404-8408
US

IV. Provider business mailing address

PO BOX 901
LAKE HAVASU CITY AZ
86405-0901
US

V. Phone/Fax

Practice location:
  • Phone: 928-486-9208
  • Fax:
Mailing address:
  • Phone: 928-486-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberSLP1281
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberSLP1281
License Number StateAZ

VIII. Authorized Official

Name: LAURIN BETH EPSTEIN
Title or Position: MANAGER
Credential: MA, CCC-SLP
Phone: 928-486-9208