Provider Demographics
NPI:1346555281
Name:MCNICHOL, LAUREN ELIZABETH MCINTOSH (AUD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH MCINTOSH
Last Name:MCNICHOL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPT OF OTOLARYNGOLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6426
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF OTOLARYNGOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5160
Practice Address - Fax:601-984-5085
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3486231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01155743Medicaid
MS01155743Medicaid
MS302I641103Medicare PIN