Healthcare Provider Details

I. General information

NPI: 1972492908
Provider Name (Legal Business Name): LAUREN DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S WISCONSIN ST STE A
HOBART IN
46342-4142
US

IV. Provider business mailing address

215 RED COACH DR
MISHAWAKA IN
46545-8307
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86063
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: