=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881844322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN SHIRA BRAND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2008
-----------------------------------------------------
Last Update Date | 10/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 BARRY ST W
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-873-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12020 CAMBRIDGE CT
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55305-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-315-4446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 9042
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------