Provider Demographics
NPI:1790466019
Name:STANLEY, LAUREN CLAIRE (MS, ACSM EP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CLAIRE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, ACSM EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S OLD KILBOURNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8900
Mailing Address - Country:US
Mailing Address - Phone:318-547-9239
Mailing Address - Fax:
Practice Address - Street 1:106 S OLD KILBOURNE RD STE B
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-8900
Practice Address - Country:US
Practice Address - Phone:318-299-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA852332224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist