Provider Demographics
NPI:1740737907
Name:MATHIEU, LAUREN KATHRYN
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KATHRYN
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 FRANKLINS WAY
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1924
Mailing Address - Country:US
Mailing Address - Phone:703-785-9663
Mailing Address - Fax:
Practice Address - Street 1:3709 SHANNONS GREEN WAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-3659
Practice Address - Country:US
Practice Address - Phone:703-596-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist