Provider Demographics
NPI:1861255507
Name:HYMANSON, LAUREN G
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:G
Last Name:HYMANSON
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 1:201 LAREINE AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1361
Mailing Address - Country:US
Mailing Address - Phone:732-977-8965
Mailing Address - Fax:
Practice Address - Street 1:201 LAREINE AVE APT 402
Practice Address - Street 2:
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1361
Practice Address - Country:US
Practice Address - Phone:732-977-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030284235Z00000X
COSLP.0005564235Z00000X
CA36079235Z00000X
CT7598235Z00000X
NJ41YS01000600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist