Provider Demographics
NPI:1225398365
Name:PALAZZOLO, LAUREN MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:PALAZZOLO
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 1:6208 US HIGHWAY 61 67
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2311
Mailing Address - Country:US
Mailing Address - Phone:636-464-4400
Mailing Address - Fax:
Practice Address - Street 1:6208 US HIGHWAY 61 67
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2311
Practice Address - Country:US
Practice Address - Phone:636-464-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011030390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist