Provider Demographics
NPI:1508204884
Name:PRENA, LAUREN ASHLEY (MED)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:PRENA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N311 DINAH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9689
Mailing Address - Country:US
Mailing Address - Phone:630-893-1810
Mailing Address - Fax:
Practice Address - Street 1:6N311 DINAH RD
Practice Address - Street 2:
Practice Address - City:MEDINAH
Practice Address - State:IL
Practice Address - Zip Code:60157-9689
Practice Address - Country:US
Practice Address - Phone:630-893-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist