Provider Demographics
NPI:1174628887
Name:JACKSON, LAUREN BREMER (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BREMER
Last Name:JACKSON
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 1:75 MCCABE DR # 19244
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-9998
Mailing Address - Country:US
Mailing Address - Phone:775-525-0866
Mailing Address - Fax:
Practice Address - Street 1:6240 SIERRA MESA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4397
Practice Address - Country:US
Practice Address - Phone:775-525-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist