Provider Demographics
NPI:1548757172
Name:TRAVERS, LAUREN (MS CCC, SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TRAVERS
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 1:8 PIERCE LN
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1598
Mailing Address - Country:US
Mailing Address - Phone:860-944-1612
Mailing Address - Fax:
Practice Address - Street 1:8 PIERCE LN
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1598
Practice Address - Country:US
Practice Address - Phone:860-944-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist