Healthcare Provider Details

I. General information

NPI: 1316204977
Provider Name (Legal Business Name): LAUREN R EYSERMANS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURE EYSERMANS M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N WASHINGTON AVE SUITE 5000
DALLAS TX
75246-1713
US

IV. Provider business mailing address

411 N WASHINGTON AVE SUITE 5000
DALLAS TX
75246-1713
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-7870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: