Provider Demographics
NPI:1053556969
Name:CHASEY, LAUREN BARBARA
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BARBARA
Last Name:CHASEY
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 1:2219 JONATHANS LNDG
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9096
Mailing Address - Country:US
Mailing Address - Phone:260-616-0370
Mailing Address - Fax:260-616-0370
Practice Address - Street 1:2219 JONATHANS LNDG
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9096
Practice Address - Country:US
Practice Address - Phone:260-616-0370
Practice Address - Fax:260-616-0370
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004731A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist