Provider Demographics
NPI:1750037461
Name:ANCONA, LAUREN ALINA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALINA
Last Name:ANCONA
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 1:1722 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4229
Mailing Address - Country:US
Mailing Address - Phone:972-571-9258
Mailing Address - Fax:
Practice Address - Street 1:3300 P AVE
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2613
Practice Address - Country:US
Practice Address - Phone:469-752-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist