Lauren Patrice Reitsma, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

019427 Issued in NY

Practice address

3085 Tierney PL
Bronx, NY 10465-4059

Phone

(718) 792-2815

NPI assigned

Aug 9, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Lauren Patrice Mellusi Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1184939779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 RIVER RD.",
            "address_2": "APT. 108",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "07047",
            "telephone_number": "917-442-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 TIERNEY PL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104654059",
            "telephone_number": "718-792-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REITSMA",
        "first_name": "LAUREN",
        "middle_name": "PATRICE",
        "name_prefix": "Mrs.",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "019427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03893212",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "MELLUSI",
            "middle_name": "PATRICE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Bronx, NY
• Providers in Bronx, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.