=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760666234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURIN B EPSTEIN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2007
-----------------------------------------------------
Last Update Date | 12/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1810 E CHESTNUT BLVD
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86404-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-486-9208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 901
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86405-0901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-486-9208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LAURIN BETH EPSTEIN
-----------------------------------------------------
Credential | MA, CCC-SLP
-----------------------------------------------------
Telephone | 928-486-9208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | SLP1281
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | SLP1281
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------