Provider Demographics
NPI:1134758014
Name:VELASQUEZ, LAURYN (MS)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAURYN
Other - Middle Name:
Other - Last Name:LOGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:9123 SE SAINT HELENS ST STE 255B
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6801
Mailing Address - Country:US
Mailing Address - Phone:310-486-2687
Mailing Address - Fax:
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 255B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6801
Practice Address - Country:US
Practice Address - Phone:503-974-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist