Provider Demographics
NPI:1639750516
Name:PEET, LAUREN MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:PEET
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 WATKINS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5494
Mailing Address - Country:US
Mailing Address - Phone:678-447-1617
Mailing Address - Fax:
Practice Address - Street 1:4040 WATKINS GLEN DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5494
Practice Address - Country:US
Practice Address - Phone:678-447-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist