Individual
LAURIE POLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP, BCBA
Contact information
Practice address
7329 WESTCHESTER, WEST BLOOMFIELD, MI 48322-2874
(248) 613-9740
Mailing address
7329 WESTCHESTER, WEST BLOOMFIELD, MI 48322-2874
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
7401000516
MI
235Z00000X
Speech-Language Pathologist
Primary
7101004275
MI
Other
Enumeration date
04/17/2017
Last updated
07/21/2020
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