Provider Demographics
NPI:1366957375
Name:WEST, LAUREL LYNNE (CCC/SP)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:LYNNE
Last Name:WEST
Suffix:
Gender:F
Credentials:CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WOODLAND HILLS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2236
Mailing Address - Country:US
Mailing Address - Phone:618-667-3859
Mailing Address - Fax:
Practice Address - Street 1:9539 US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:SAINT JACOB
Practice Address - State:IL
Practice Address - Zip Code:62281-1309
Practice Address - Country:US
Practice Address - Phone:618-667-5406
Practice Address - Fax:618-644-9435
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist