Provider Demographics
NPI:1972975613
Name:RUNKEL, LAUREN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:RUNKEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:DEMERCHANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:690 WOODBINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2430
Mailing Address - Country:US
Mailing Address - Phone:401-741-2315
Mailing Address - Fax:
Practice Address - Street 1:751 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5328
Practice Address - Country:US
Practice Address - Phone:781-380-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist