Provider Demographics
NPI:1386176105
Name:VANZANT, LAUREN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VANZANT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 FOX RUN TRL
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7643
Mailing Address - Country:US
Mailing Address - Phone:816-813-0393
Mailing Address - Fax:
Practice Address - Street 1:721 METROPOLITAN AVE STE C
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1469
Practice Address - Country:US
Practice Address - Phone:913-362-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4011235Z00000X
MO2014028362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13982108OtherCAQH