Healthcare Provider Details

I. General information

NPI: 1720565229
Provider Name (Legal Business Name): LAUREN WASSERBERGER M.A.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 PERRY RD
APEX NC
27502-7701
US

IV. Provider business mailing address

8510 MOUNT VALLEY LN
RALEIGH NC
27613-6930
US

V. Phone/Fax

Practice location:
  • Phone: 813-480-0589
  • Fax:
Mailing address:
  • Phone: 813-480-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13178
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: