Provider Demographics
NPI:1447864681
Name:SHEETZ, LAUREN MARIE (CF-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:SHEETZ
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 NW 3RD AVE APT 532
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7598
Mailing Address - Country:US
Mailing Address - Phone:203-217-4995
Mailing Address - Fax:
Practice Address - Street 1:1626 DAVIS RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5640
Practice Address - Country:US
Practice Address - Phone:561-439-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program