Provider Demographics
NPI:1508986043
Name:WILL, LAUREN ALEXIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ALEXIS
Last Name:WILL
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 1:9528 PERRY HALL BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1340
Mailing Address - Country:US
Mailing Address - Phone:443-604-5772
Mailing Address - Fax:
Practice Address - Street 1:100 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-0704
Practice Address - Country:US
Practice Address - Phone:410-825-9445
Practice Address - Fax:410-296-5710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05333235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist