Healthcare Provider Details

I. General information

NPI: 1356060271
Provider Name (Legal Business Name): LAKEN AUBREI ROSENTHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 DAVENPORT AVE
SAGINAW MI
48602-3495
US

IV. Provider business mailing address

1144 W HAMPTON RD
ESSEXVILLE MI
48732-3201
US

V. Phone/Fax

Practice location:
  • Phone: 989-860-0846
  • Fax:
Mailing address:
  • Phone: 989-975-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: