Provider Demographics
NPI:1477105112
Name:PEACE, LAUREN CALLIE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CALLIE
Last Name:PEACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 GROVE PARK LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5810
Mailing Address - Country:US
Mailing Address - Phone:769-798-0470
Mailing Address - Fax:
Practice Address - Street 1:1733 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1345
Practice Address - Country:US
Practice Address - Phone:334-699-8878
Practice Address - Fax:334-699-5175
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL190041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist