Provider Demographics
NPI:1720057656
Name:NORWOOD, LAUREN BRENNAN (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRENNAN
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 GALILEE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-4166
Mailing Address - Country:US
Mailing Address - Phone:678-643-3908
Mailing Address - Fax:
Practice Address - Street 1:1157 GALILEE CHURCH RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-4166
Practice Address - Country:US
Practice Address - Phone:678-643-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA888472112AMedicaid