Provider Demographics
NPI:1073130795
Name:MUPANOMUNDA, LAUREN ANDREA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANDREA
Last Name:MUPANOMUNDA
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 1:1275 ROCK AVE APT N8
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3545
Mailing Address - Country:US
Mailing Address - Phone:732-485-2474
Mailing Address - Fax:
Practice Address - Street 1:945 RIVER AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5675
Practice Address - Country:US
Practice Address - Phone:732-833-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist