MEDICARE: LAUREN MARIE BIEDEBACH MS/CCC-SLP

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	1320	NV

General Provider Information

NPI Number	:	1912293911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MARIE BIEDEBACH MS/CCC-SLP

Provider Business Mailing Address
First Line	:	5552 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7695
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:	702-399-8255

Provider Business Practice Location Address
First Line	:	5552 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7695
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:	702-399-8255

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	12/28/2011

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