Healthcare Provider Details

I. General information

NPI: 1265204077
Provider Name (Legal Business Name): LAZZARONI PEDIATRIC SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 N INDIANA AVE
CROWN POINT IN
46307-3412
US

IV. Provider business mailing address

14003 SOUTH ANNAPOLIS COURT
CEDAR LAKE IN
46303
US

V. Phone/Fax

Practice location:
  • Phone: 219-200-4077
  • Fax:
Mailing address:
  • Phone: 708-220-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN LAZZARONI
Title or Position: OWNER
Credential:
Phone: 219-200-4077