Provider Demographics
NPI:1356886147
Name:KRAUS, LAUREN MICHELLE (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:KRAUS
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:CALCAGNINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP, TSSLD
Mailing Address - Street 1:4362 OAK ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041
Mailing Address - Country:US
Mailing Address - Phone:315-440-5730
Mailing Address - Fax:
Practice Address - Street 1:7854 OSWEGO RD STE 104E
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2137
Practice Address - Country:US
Practice Address - Phone:315-516-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027433235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05301735Medicaid