Provider Demographics
NPI:1306490388
Name:REYNOLDS, LAUREN CLARE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CLARE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6789 ELM VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7476
Mailing Address - Country:US
Mailing Address - Phone:269-544-3230
Mailing Address - Fax:
Practice Address - Street 1:6789 ELM VALLEY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7476
Practice Address - Country:US
Practice Address - Phone:269-544-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist