Provider Demographics
NPI:1043643273
Name:SMITH, LAUREN DENISE (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W TEXAS ST APT 39
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4470
Mailing Address - Country:US
Mailing Address - Phone:480-201-7329
Mailing Address - Fax:
Practice Address - Street 1:2100 W TEXAS ST APT 39
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4470
Practice Address - Country:US
Practice Address - Phone:480-201-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist