Provider Demographics
NPI:1083420806
Name:RANDAZZO, LAUREN ASHLEY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1420 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5437
Mailing Address - Country:US
Mailing Address - Phone:260-705-6625
Mailing Address - Fax:
Practice Address - Street 1:760 RED OAK LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3816
Practice Address - Country:US
Practice Address - Phone:260-705-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist