Provider Demographics
NPI:1265002687
Name:BIRD, LAUREN TAYLOR (MS, CFY/SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:BIRD
Suffix:
Gender:F
Credentials:MS, CFY/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18711 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:RAWLINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21557-1028
Mailing Address - Country:US
Mailing Address - Phone:301-697-5874
Mailing Address - Fax:
Practice Address - Street 1:108 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2931
Practice Address - Country:US
Practice Address - Phone:301-697-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02270L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist