Provider Demographics
NPI:1699454272
Name:POKALLUS, LAURYN NORAH
Entity type:Individual
Prefix:MISS
First Name:LAURYN
Middle Name:NORAH
Last Name:POKALLUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 CAPITOL SQUARE PL SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2416
Mailing Address - Country:US
Mailing Address - Phone:770-315-4885
Mailing Address - Fax:
Practice Address - Street 1:3801 CONNECTICUT AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4530
Practice Address - Country:US
Practice Address - Phone:202-525-1641
Practice Address - Fax:202-299-0590
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLPCF2000100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist