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General NPI Number Information
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NPI Number | 1003674144
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Entity Type | Individual
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Provider Name | LAUREN KELLY NYITRAY
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Gender | Female
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 419 S CORAL ST
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City | KALKASKA
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State | MI
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Zip | 49646-2503
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Country | US
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Telephone | 231-258-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 3639 MATADOR W APT 55
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4652
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Country | US
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Telephone | 734-929-8577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7152000558
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License Number State | MI
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