Provider Demographics
NPI:1194854109
Name:MCINDOO, LAUREN J (CCC-SLP, LIC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:J
Last Name:MCINDOO
Suffix:
Gender:F
Credentials:CCC-SLP, LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 PLUM HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3625
Mailing Address - Country:US
Mailing Address - Phone:315-413-0080
Mailing Address - Fax:
Practice Address - Street 1:215 BASSETT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2113
Practice Address - Country:US
Practice Address - Phone:315-472-4404
Practice Address - Fax:315-478-2337
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008591-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist