Provider Demographics
NPI:1437756657
Name:FORTI, LAUREN ELAINE (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE
Last Name:FORTI
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BRIDGEMILL AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-2619
Mailing Address - Country:US
Mailing Address - Phone:770-846-3267
Mailing Address - Fax:
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 603604
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2394
Practice Address - Country:US
Practice Address - Phone:770-974-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist