Provider Demographics
NPI:1639106875
Name:GROMEL, LAUREN L (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:GROMEL
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MEREDITH
Other - Last Name:LUKSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:212 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4704
Mailing Address - Country:US
Mailing Address - Phone:570-759-1113
Mailing Address - Fax:570-759-1135
Practice Address - Street 1:212 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4704
Practice Address - Country:US
Practice Address - Phone:570-759-1113
Practice Address - Fax:570-759-1135
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000946L231H00000X, 237600000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA293897RGQMedicare ID - Type Unspecified