Provider Demographics
NPI:1073926721
Name:DAVIS, LAUREN M (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 NORTH CLOVERLEAF DRIVE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6436
Mailing Address - Country:US
Mailing Address - Phone:636-441-7470
Mailing Address - Fax:636-441-4270
Practice Address - Street 1:4200 N CLOVERLEAF DRIVE, SUITE B
Practice Address - Street 2:
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-441-7470
Practice Address - Fax:636-441-4270
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
MO2015010533231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231H00000XMedicare PIN
IL237600000XMedicare PIN