1598929622 NPI number — MS. LAUREN ASHLEY ROBERTS M.S. CCC-SLP

Table of content: MS. LAUREN ASHLEY ROBERTS M.S. CCC-SLP (NPI 1598929622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598929622 NPI number — MS. LAUREN ASHLEY ROBERTS M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
LAUREN
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WICK
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598929622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 3887-DUMC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-684-6271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 BAKER HOUSE TRENT DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-6271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  8189 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 8189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)