Healthcare Provider Details

I. General information

NPI: 1245793173
Provider Name (Legal Business Name): LAUREN KLEINERT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS ROAD
PHOENIX AZ
85016
US

IV. Provider business mailing address

1919 E THOMAS ROAD
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0879
  • Fax:
Mailing address:
  • Phone: 602-933-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP9420
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: