Provider Demographics
NPI:1285373357
Name:VERNON, MARY-LAUREN CAMPO (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY-LAUREN
Middle Name:CAMPO
Last Name:VERNON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3205 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2039
Mailing Address - Country:US
Mailing Address - Phone:936-709-2556
Mailing Address - Fax:
Practice Address - Street 1:2575 ED KHARBAT DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2368
Practice Address - Country:US
Practice Address - Phone:936-709-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist