Provider Demographics
NPI:1629618525
Name:DAVENPORT, LAUREN CYNTHIA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CYNTHIA
Last Name:DAVENPORT
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 1:21 RYLEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8072
Mailing Address - Country:US
Mailing Address - Phone:501-454-8758
Mailing Address - Fax:
Practice Address - Street 1:1401 MURRELL TAYLOR DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-8118
Practice Address - Country:US
Practice Address - Phone:501-985-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist