Provider Demographics
NPI:1407383656
Name:FERREIRA, LAUREN KATHRYN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KATHRYN
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:KATHRYN
Other - Last Name:BOYLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:120 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1600
Mailing Address - Country:US
Mailing Address - Phone:508-230-8181
Mailing Address - Fax:
Practice Address - Street 1:120 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379
Practice Address - Country:US
Practice Address - Phone:508-230-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14296461OtherASHA CCCS
MA76794OtherSTATE LICENSE