Healthcare Provider Details

I. General information

NPI: 1215862131
Provider Name (Legal Business Name): LAURYN MAKENZIE LEE SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 GREENWAY DR STE 500
IRVING TX
75038-2444
US

IV. Provider business mailing address

1431 GREENWAY DR STE 500
IRVING TX
75038-2444
US

V. Phone/Fax

Practice location:
  • Phone: 877-688-2520
  • Fax: 214-741-3655
Mailing address:
  • Phone: 877-688-2520
  • Fax: 214-741-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: