Healthcare Provider Details

I. General information

NPI: 1720539596
Provider Name (Legal Business Name): LAUREN ANNE GARRIGUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43279 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

IV. Provider business mailing address

43279 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-4601
  • Fax: 313-347-1652
Mailing address:
  • Phone: 313-278-4601
  • Fax: 313-347-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152000301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: