Provider Demographics
NPI:1609049139
Name:MILES, LAUREN MELCHIORRE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MELCHIORRE
Last Name:MILES
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 COLONY AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7833
Mailing Address - Country:US
Mailing Address - Phone:847-224-3179
Mailing Address - Fax:
Practice Address - Street 1:722 COLONY AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-7833
Practice Address - Country:US
Practice Address - Phone:847-224-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist