Provider Demographics
NPI:1821420175
Name:O'CONNOR, LAUREN ALICIA (MS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALICIA
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0810
Mailing Address - Country:US
Mailing Address - Phone:530-318-6418
Mailing Address - Fax:
Practice Address - Street 1:1699 OLD MAMMOTH RD APT 4
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-6445
Practice Address - Country:US
Practice Address - Phone:530-318-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist