MEDICARE: LAURYN DOUSSETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101008900	MI

General Provider Information

NPI Number	:	1043701212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURYN DOUSSETT

Provider Business Mailing Address
First Line	:	7711 AUDUBON LN
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-6601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 FORT ST
Second Line	:
City	:	TRENTON
State	:	MI
Zip	:	48183-2003
Country	:	US
Telephone Number	:	734-304-4159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/29/2024

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Directions to “ LAURYN DOUSSETT ” Practice Location

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