Provider Demographics
NPI:1720403603
Name:VINCENT, LAUREN RENEE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RENEE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27000 ARTHUR BAKER RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9185
Mailing Address - Country:US
Mailing Address - Phone:317-850-3055
Mailing Address - Fax:
Practice Address - Street 1:27000 ARTHUR BAKER RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-9185
Practice Address - Country:US
Practice Address - Phone:317-850-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001967A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer