Provider Demographics
NPI:1972269363
Name:DUFFY, LAUREN JOHANNA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JOHANNA
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KNOLLS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1513
Mailing Address - Country:US
Mailing Address - Phone:973-557-7542
Mailing Address - Fax:
Practice Address - Street 1:15 HALKO DR
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1380
Practice Address - Country:US
Practice Address - Phone:973-829-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00975400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist