Provider Demographics
NPI:1699174003
Name:WAITS, LAURYN LYN (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:LYN
Last Name:WAITS
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3206
Mailing Address - Country:US
Mailing Address - Phone:505-994-3305
Mailing Address - Fax:505-994-3316
Practice Address - Street 1:450 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3206
Practice Address - Country:US
Practice Address - Phone:505-994-3305
Practice Address - Fax:505-994-3316
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist