Provider Demographics
NPI:1619457306
Name:RICHARDS, LAUREN ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1735
Mailing Address - Country:US
Mailing Address - Phone:317-690-7070
Mailing Address - Fax:
Practice Address - Street 1:6516 KANE AVE
Practice Address - Street 2:
Practice Address - City:HODGKINS
Practice Address - State:IL
Practice Address - Zip Code:60525-7618
Practice Address - Country:US
Practice Address - Phone:708-482-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1215632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992820757Medicaid