Provider Demographics
NPI:1831826742
Name:BRACALE, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BRACALE
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 1:7298 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-7614
Mailing Address - Country:US
Mailing Address - Phone:419-560-3795
Mailing Address - Fax:614-388-5995
Practice Address - Street 1:8740 ORION PL STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4063
Practice Address - Country:US
Practice Address - Phone:614-734-7777
Practice Address - Fax:614-388-5995
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.14917OtherSTATE BOARD