Provider Demographics
NPI:1043729023
Name:MANZELLA MAULUCCI, LAUREN (MS ED CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MANZELLA MAULUCCI
Suffix:
Gender:F
Credentials:MS ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 W CARMEN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2202
Mailing Address - Country:US
Mailing Address - Phone:716-864-6448
Mailing Address - Fax:
Practice Address - Street 1:17470 BROOKSIDE TRACE CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-6201
Practice Address - Country:US
Practice Address - Phone:813-600-5994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist