Provider Demographics
NPI:1922404961
Name:JOHNSON, LAUREN (SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16052 BEACH BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3853
Mailing Address - Country:US
Mailing Address - Phone:714-916-0641
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD STE 215
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3853
Practice Address - Country:US
Practice Address - Phone:714-916-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP20590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist