Provider Demographics
NPI:1194357517
Name:FOOTE, LAUREN LYNNE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:LYNNE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6965
Mailing Address - Country:US
Mailing Address - Phone:904-713-7752
Mailing Address - Fax:
Practice Address - Street 1:4101 COLLEGE ST # 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5318
Practice Address - Country:US
Practice Address - Phone:904-387-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FLSZ9426235Z00000X
FLSA18700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist