Provider Demographics
NPI:1417336041
Name:LEE, LAUREN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RAE
Other - Last Name:CANNISTRACI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1573 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3740
Mailing Address - Country:US
Mailing Address - Phone:508-617-8396
Mailing Address - Fax:508-401-2696
Practice Address - Street 1:1573 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3740
Practice Address - Country:US
Practice Address - Phone:508-617-8396
Practice Address - Fax:508-401-2696
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00303-P235Z00000X
MA76625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISR21880Medicaid
RISR21880Medicaid