Provider Demographics
NPI:1881265759
Name:ALLEN, LAUREN ALEXIS
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28273 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-7531
Mailing Address - Country:US
Mailing Address - Phone:626-232-9237
Mailing Address - Fax:
Practice Address - Street 1:STAR SPEECH AND OCCUPATIONAL THERAPY
Practice Address - Street 2:12222 W BRIDGER BAY DR
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669
Practice Address - Country:US
Practice Address - Phone:208-503-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist