MEDICARE: LAUREN SHERWOOD

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548787633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN SHERWOOD

Provider Business Mailing Address
First Line	:	4129 S MEADOWS RD APT 1023
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4129 S MEADOWS RD, APT #1023
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507
Country	:	US
Telephone Number	:	812-606-7380
Fax Number	:

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

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	08/29/2017

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Directions to “ LAUREN SHERWOOD ” Practice Location

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