Provider Demographics
NPI:1053891788
Name:CERZA, LAUREN ALEXIS
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:CERZA
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 1:251 W MOHAWK LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5946
Mailing Address - Country:US
Mailing Address - Phone:602-467-6999
Mailing Address - Fax:
Practice Address - Street 1:251 W MOHAWK LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5946
Practice Address - Country:US
Practice Address - Phone:602-467-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP11364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist