Healthcare Provider Details

I. General information

NPI: 1780150664
Provider Name (Legal Business Name): LAUREN STAWECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 COMMERCE RD STE 1
COMMERCE TWP MI
48382-4484
US

IV. Provider business mailing address

6247 CHAD CT
BRIGHTON MI
48116-1794
US

V. Phone/Fax

Practice location:
  • Phone: 947-223-1609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number71001004731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: