Provider Demographics
NPI:1548576341
Name:WALLICK, LAUREN ELIZABETH (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WALLICK
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CAMEO CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7911
Mailing Address - Country:US
Mailing Address - Phone:330-232-2689
Mailing Address - Fax:
Practice Address - Street 1:311 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2157
Practice Address - Country:US
Practice Address - Phone:864-231-7397
Practice Address - Fax:864-231-7396
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist