Provider Demographics
NPI:1194290569
Name:WYSKIEL, LAUREN (SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WYSKIEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CONNOLLY PKWY BLDG 17A
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2532
Mailing Address - Country:US
Mailing Address - Phone:203-230-2185
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY BLDG 17A
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2532
Practice Address - Country:US
Practice Address - Phone:203-230-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist