Healthcare Provider Details

I. General information

NPI: 1487037545
Provider Name (Legal Business Name): LAUREN MARY SNYDER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13059 E PEAKVIEW AVE
CENTENNIAL CO
80111-6511
US

IV. Provider business mailing address

13059 E PEAKVIEW AVE
CENTENNIAL CO
80111-6511
US

V. Phone/Fax

Practice location:
  • Phone: 307-851-5881
  • Fax:
Mailing address:
  • Phone: 307-851-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9426862-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: