Provider Demographics
NPI:1821725714
Name:ROWE, LAUREN REBECCA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:REBECCA
Last Name:ROWE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ADAMS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4817
Mailing Address - Country:US
Mailing Address - Phone:478-254-0636
Mailing Address - Fax:912-525-2847
Practice Address - Street 1:400 ADAMS ST UNIT B
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4817
Practice Address - Country:US
Practice Address - Phone:478-254-0636
Practice Address - Fax:912-525-2847
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist