Provider Demographics
NPI:1548658172
Name:HIMMIGHOEFER, LAUREN (CCC, SLP, BCBA LABA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HIMMIGHOEFER
Suffix:
Gender:F
Credentials:CCC, SLP, BCBA LABA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MOSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 STOWE RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1409
Mailing Address - Country:US
Mailing Address - Phone:086-411-3835
Mailing Address - Fax:
Practice Address - Street 1:691 GRAFTON ST STE 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3185
Practice Address - Country:US
Practice Address - Phone:508-304-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3677103K00000X
MA9182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225760Medicare PIN