Individual provider Active NPI

Lauren Leclercq, AUD

  • Audiologist
  • Paw Paw, MI
National Provider Identifier
1720605298
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1601001058 Issued in MI
Practice address
179 W Michigan Ave Ste a
Paw Paw, MI 49079-1444
Phone
(269) 359-1346
Fax
(630) 303-5385
NPI assigned
Jul 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 147.001773 IL
Audiologist 231H00000X 1601001058 MI Primary

Addresses

Primary practice location

179 W Michigan Ave Ste a
Paw Paw, MI 49079-1444

Mailing address

179 W Michigan Ave Ste a
Paw Paw, MI 49079-1444
Phone (269) 359-1346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230905002944 MI Practitioner - Qualified Audiologist 8426476797 Reassigns benefits to 1 organization
I20240214002340 IN Practitioner - Qualified Audiologist 8426476797 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Services Company USA, LLC Audiologist CurrentSince Jul 31, 2023 Accepting new patients
Audiology Services Company USA, LLC CurrentSince Jul 31, 2023 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients

Locations

1653 Thornapple Cir
Valparaiso, IN 46385
Phone (219) 477-4473

1052 Cleaver Rd
Caro, MI 48723
Phone (989) 673-2933

179 W Michigan Ave
Ste A
Paw Paw, MI 49079
Phone (269) 327-3333

1930 W Milham Ave
Ste B
Portage, MI 49024
Phone (269) 327-3333

113 E Long Lake Rd
Ste B
Troy, MI 48085
Phone (248) 435-6811

2501 Cottontail Ln
Somerset, NJ 08873
Phone (732) 529-7120

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1720605298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 W MICHIGAN AVE STE A",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791444",
            "telephone_number": "269-359-1346",
            "fax_number": "630-303-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 W MICHIGAN AVE STE A",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791444",
            "telephone_number": "269-359-1346",
            "fax_number": "630-303-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECLERCQ",
        "first_name": "LAUREN",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IL",
            "license": "147.001773",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601001058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.