Provider Demographics
NPI:1194443382
Name:OTT, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WINDERMERE ROAD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:ENGLAND
Mailing Address - Zip Code:W5 4TD
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78 WINDERMERE ROAD
Practice Address - Street 2:LONDON
Practice Address - City:LONDON
Practice Address - State:ENGLAND
Practice Address - Zip Code:W5 4TD
Practice Address - Country:GB
Practice Address - Phone:816-514-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14281602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist