Provider Demographics
NPI:1548745680
Name:WHITLOCK, LAUREN B (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:WHITLOCK
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 1:87 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-2949
Mailing Address - Country:US
Mailing Address - Phone:804-349-7255
Mailing Address - Fax:
Practice Address - Street 1:10295 CHAMBERLAYNE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-4001
Practice Address - Country:US
Practice Address - Phone:804-349-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist