Provider Demographics
NPI:1356821797
Name:LANGHAM, LAUREN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:LANGHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 MOUNT ZION RD NW
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-9035
Mailing Address - Country:US
Mailing Address - Phone:601-754-8454
Mailing Address - Fax:
Practice Address - Street 1:4109 HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-9132
Practice Address - Country:US
Practice Address - Phone:601-276-3900
Practice Address - Fax:601-276-3938
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist