Provider Demographics
NPI:1083014831
Name:VASQUEZ, LAUREN MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:MATTERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:20 TAYLOR STREET
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-459-7869
Mailing Address - Fax:
Practice Address - Street 1:20 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4010
Practice Address - Country:US
Practice Address - Phone:631-459-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist