Provider Demographics
NPI:1447402789
Name:CARROLL, LAUREN RENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:RENEE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT AIRY RD W
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-3212
Mailing Address - Country:US
Mailing Address - Phone:917-597-8579
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT AIRY RD W
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-3212
Practice Address - Country:US
Practice Address - Phone:917-597-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014945-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014945-1OtherSPEECH LANGUAGE PATHOLOGIST
014945-1OtherNYS LICENSE