Provider Demographics
NPI:1457878399
Name:YATES, LAUREN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 DEVONSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7472
Mailing Address - Country:US
Mailing Address - Phone:770-329-5596
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY STE 1001
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:678-644-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009834235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist