Provider Demographics
NPI:1023538188
Name:MUNDY, LAUREN THERESA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:THERESA
Last Name:MUNDY
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 1:12147 PENZANCE LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-6310
Mailing Address - Country:US
Mailing Address - Phone:727-967-0810
Mailing Address - Fax:
Practice Address - Street 1:6245 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6006
Practice Address - Country:US
Practice Address - Phone:727-376-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist