Provider Demographics
NPI:1265809966
Name:CLANCEY, LAUREN FORRESTER (AUD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:FORRESTER
Last Name:CLANCEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1253
Mailing Address - Fax:360-729-3185
Practice Address - Street 1:1200 HILYARD ST STE 620
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8157
Practice Address - Country:US
Practice Address - Phone:458-205-6500
Practice Address - Fax:458-205-6453
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30834231H00000X
OR030834231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500691342Medicaid
WA2072951Medicaid
WA2072951Medicaid
OR500691342Medicaid