Provider Demographics
NPI:1467179077
Name:MERRILL, LAUREN DENA (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DENA
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1508
Mailing Address - Country:US
Mailing Address - Phone:530-680-9723
Mailing Address - Fax:
Practice Address - Street 1:123 TERRACE DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1508
Practice Address - Country:US
Practice Address - Phone:530-680-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA23537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist