Provider Demographics
NPI:1225275225
Name:WRIGHT, LAUREN M (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26831 RIVERFORD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5457
Mailing Address - Country:US
Mailing Address - Phone:419-367-5367
Mailing Address - Fax:
Practice Address - Street 1:26831 RIVERFORD DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5457
Practice Address - Country:US
Practice Address - Phone:419-367-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2007170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.8995OtherOHIO SPEECH LICENSE