Provider Demographics
NPI:1104304005
Name:BURKHARDT, LAUREN (MA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15155 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8922
Mailing Address - Country:US
Mailing Address - Phone:616-502-8424
Mailing Address - Fax:
Practice Address - Street 1:16930 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2787
Practice Address - Country:US
Practice Address - Phone:616-935-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist