Provider Demographics
NPI:1720439334
Name:KING, LAUREN BREANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BREANN
Last Name:KING
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 1:31083 LITTLE CAMILLE WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-4900
Mailing Address - Country:US
Mailing Address - Phone:951-746-5080
Mailing Address - Fax:
Practice Address - Street 1:2200 HAMNER AVE STE 107
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2673
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:951-893-5135
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP23557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist