Provider Demographics
NPI:1336803782
Name:VANDERLAAN, LAUREN BETHANY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BETHANY
Last Name:VANDERLAAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUVALL ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3210
Mailing Address - Country:US
Mailing Address - Phone:469-302-4000
Mailing Address - Fax:
Practice Address - Street 1:4101 SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-1840
Practice Address - Country:US
Practice Address - Phone:469-302-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist