Healthcare Provider Details

I. General information

NPI: 1124560677
Provider Name (Legal Business Name): LAUREN FREY M.A., CCC-SLP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10577 ACACIA PARK PL
LAS VEGAS NV
89135-1243
US

IV. Provider business mailing address

10577 ACACIA PARK PL
LAS VEGAS NV
89135-1243
US

V. Phone/Fax

Practice location:
  • Phone: 814-873-5365
  • Fax:
Mailing address:
  • Phone: 814-873-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-147666
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1689
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: