Provider Demographics
NPI:1346788759
Name:CAPELLO, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CAPELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9011
Mailing Address - Country:US
Mailing Address - Phone:936-328-8148
Mailing Address - Fax:936-327-2491
Practice Address - Street 1:440 HIGHWAY 59 LOOP S STE 104
Practice Address - Street 2:SUITE 104
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9011
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist