Provider Demographics
NPI:1710407507
Name:WYSOCKI, LAUREN LEIGH (CF-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:WYSOCKI
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15641 HEATHERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2307
Mailing Address - Country:US
Mailing Address - Phone:708-408-2688
Mailing Address - Fax:
Practice Address - Street 1:15641 HEATHERGLEN DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2307
Practice Address - Country:US
Practice Address - Phone:708-408-2688
Practice Address - Fax:708-408-2688
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist