Provider Demographics
NPI:1699787614
Name:WOODWARD, LAUREN ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2221 W DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3628
Mailing Address - Country:US
Mailing Address - Phone:918-809-5483
Mailing Address - Fax:918-250-8467
Practice Address - Street 1:4404 W. LOUISVILLE ST.
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8870
Practice Address - Country:US
Practice Address - Phone:918-809-5483
Practice Address - Fax:918-250-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100642550 CMedicaid