Provider Demographics
NPI:1326211764
Name:LENNON, LAURIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:LENNON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54559
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0559
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:714-456-2979
Practice Address - Street 1:1915 W ORANGEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2047
Practice Address - Country:US
Practice Address - Phone:714-456-2986
Practice Address - Fax:714-456-2979
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist