Provider Demographics
NPI:1184124042
Name:LAUREN COOK SPEECH & LANGUAGE
Entity type:Organization
Organization Name:LAUREN COOK SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:MANDRELLE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:847-322-1126
Mailing Address - Street 1:210 N 86TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4608
Mailing Address - Country:US
Mailing Address - Phone:847-322-1126
Mailing Address - Fax:847-322-1126
Practice Address - Street 1:210 N 86TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4608
Practice Address - Country:US
Practice Address - Phone:847-322-1126
Practice Address - Fax:847-322-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3299-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty