Provider Demographics
NPI:1821725649
Name:ELLIS, LAUREN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:ELLIS
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 1:760 MAXINE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5930
Mailing Address - Country:US
Mailing Address - Phone:225-769-6845
Mailing Address - Fax:
Practice Address - Street 1:760 MAXINE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5930
Practice Address - Country:US
Practice Address - Phone:225-769-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist