Provider Demographics
NPI:1356798482
Name:MACLEOD, LAUREN (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:MACLEOD
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 1:1031 N CRESCENT HEIGHTS BLVD
Mailing Address - Street 2:#1D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6052
Mailing Address - Country:US
Mailing Address - Phone:407-448-2849
Mailing Address - Fax:
Practice Address - Street 1:505 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2015
Practice Address - Country:US
Practice Address - Phone:407-448-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist