Provider Demographics
NPI:1962674267
Name:MANGRUM, LAUREN A (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:A
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 BYRON CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7834
Mailing Address - Country:US
Mailing Address - Phone:240-586-9961
Mailing Address - Fax:
Practice Address - Street 1:3636 BYRON CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7834
Practice Address - Country:US
Practice Address - Phone:240-586-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist