Provider Demographics
NPI:1225405699
Name:TERRAZAS, LAUREN WILEY
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:WILEY
Last Name:TERRAZAS
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 1:115 SANDRA MURAIDA WAY
Mailing Address - Street 2:APT 241
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4696
Mailing Address - Country:US
Mailing Address - Phone:914-582-0936
Mailing Address - Fax:
Practice Address - Street 1:12710 RESEARCH BLVD STE 395
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4397
Practice Address - Country:US
Practice Address - Phone:512-250-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty