Provider Demographics
NPI:1891721734
Name:CLINTON, LAUREN JOANN (AU D)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JOANN
Last Name:CLINTON
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JOANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2611 PRINGLE RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1533
Mailing Address - Country:US
Mailing Address - Phone:503-385-4582
Mailing Address - Fax:503-540-4473
Practice Address - Street 1:2611 PRINGLE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1533
Practice Address - Country:US
Practice Address - Phone:503-385-4582
Practice Address - Fax:503-540-4473
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22745231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027736Medicaid
OR134800Medicare ID - Type Unspecified