Provider Demographics
NPI:1164240222
Name:PARK, LAUREN MELISSA (MA SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MELISSA
Last Name:PARK
Suffix:
Gender:F
Credentials:MA SLP-CCC
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Other - Credentials:
Mailing Address - Street 1:7922 DAY CREEK BLVD APT 4302
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8590
Mailing Address - Country:US
Mailing Address - Phone:330-473-8105
Mailing Address - Fax:
Practice Address - Street 1:870 N MOUNTAIN AVE STE 118
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4173
Practice Address - Country:US
Practice Address - Phone:909-278-7042
Practice Address - Fax:909-575-6209
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN22009233A235Z00000X
CA39936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist