Provider Demographics
NPI:1154713469
Name:HAZEL, LAUREN (MS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HAZEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HAZEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:826 KIOWA
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-4079
Mailing Address - Country:US
Mailing Address - Phone:928-310-4428
Mailing Address - Fax:
Practice Address - Street 1:826 KIOWA
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-4079
Practice Address - Country:US
Practice Address - Phone:928-310-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP9308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist