Provider Demographics
NPI:1205252012
Name:BRADY, LAUREN (SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 REAGAN ST
Mailing Address - Street 2:APT D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7107
Mailing Address - Country:US
Mailing Address - Phone:915-433-2186
Mailing Address - Fax:
Practice Address - Street 1:302 E FREEMAN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4813
Practice Address - Country:US
Practice Address - Phone:972-708-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist