Provider Demographics
NPI:1720506496
Name:PELGRIN, LAUREN R
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:PELGRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9136
Mailing Address - Country:US
Mailing Address - Phone:814-389-3683
Mailing Address - Fax:
Practice Address - Street 1:35 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9428
Practice Address - Country:US
Practice Address - Phone:910-436-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist