Provider Demographics
NPI:1295037695
Name:BUDD, LAUREN MERRILL (MS SLP-CCC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MERRILL
Last Name:BUDD
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 MAEDER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2044
Mailing Address - Country:US
Mailing Address - Phone:516-992-1869
Mailing Address - Fax:
Practice Address - Street 1:1439 MAEDER AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2044
Practice Address - Country:US
Practice Address - Phone:516-992-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid