Healthcare Provider Details

I. General information

NPI: 1912270711
Provider Name (Legal Business Name): LAUREN JUMP MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130D SNOW BRIDGE LN
KERNERSVILLE NC
27284-8411
US

IV. Provider business mailing address

8525 HAW RIVER RD
OAK RIDGE NC
27310-9832
US

V. Phone/Fax

Practice location:
  • Phone: 336-904-0467
  • Fax:
Mailing address:
  • Phone: 336-430-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7811
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: