Provider Demographics
NPI:1124560677
Name:FREY, LAUREN (MA, CCC-SLP, IBCLC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:MA, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10577 ACACIA PARK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1243
Mailing Address - Country:US
Mailing Address - Phone:814-873-5365
Mailing Address - Fax:
Practice Address - Street 1:10577 ACACIA PARK PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1243
Practice Address - Country:US
Practice Address - Phone:814-873-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-147666174N00000X
NVSP-1689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN