Provider Demographics
NPI:1659860328
Name:SHRUM, LARA NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:NICOLE
Last Name:SHRUM
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 1:391 MUZZLELOADER LN APT 101
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-1155
Mailing Address - Country:US
Mailing Address - Phone:724-317-3751
Mailing Address - Fax:
Practice Address - Street 1:1323 SALEM AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3542
Practice Address - Country:US
Practice Address - Phone:301-766-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist