Provider Demographics
NPI:1750572905
Name:HENDRICKSON, LAUREN E (AUD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 S EMERSON AVE
Mailing Address - Street 2:STE H
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8668
Mailing Address - Country:US
Mailing Address - Phone:317-300-0370
Mailing Address - Fax:317-300-0422
Practice Address - Street 1:1180 MEDICAL CT STE A
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2986
Practice Address - Country:US
Practice Address - Phone:317-818-3490
Practice Address - Fax:317-536-3541
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002419A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200863940Medicaid
IN100239360DMedicaid
IN200863940Medicaid