Provider Demographics
NPI:1871940668
Name:LORENZ, RAELYNNE SPRACKLEN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RAELYNNE
Middle Name:SPRACKLEN
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LUCERO ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2620
Mailing Address - Country:US
Mailing Address - Phone:805-492-3543
Mailing Address - Fax:
Practice Address - Street 1:122 LUCERO ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2620
Practice Address - Country:US
Practice Address - Phone:805-492-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist