Healthcare Provider Details

I. General information

NPI: 1497669501
Provider Name (Legal Business Name): LAUREN TABOR M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W MAIN ST
MECOSTA MI
49332-9698
US

IV. Provider business mailing address

15760 190TH AVE
BIG RAPIDS MI
49307-9096
US

V. Phone/Fax

Practice location:
  • Phone: 231-660-0145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004847
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: