Provider Demographics
NPI:1508153727
Name:MANDRELLE, LAUREN T (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:MANDRELLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:THERESA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:210 N 86TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4608
Mailing Address - Country:US
Mailing Address - Phone:867-322-1126
Mailing Address - Fax:
Practice Address - Street 1:210 N 86TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4608
Practice Address - Country:US
Practice Address - Phone:847-322-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist