Healthcare Provider Details

I. General information

NPI: 1477100121
Provider Name (Legal Business Name): LAUREN GUMPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VOLVO PKWY STE 320
CHESAPEAKE VA
23320-3341
US

IV. Provider business mailing address

1100 VOLVO PKWY STE 320
CHESAPEAKE VA
23320-3341
US

V. Phone/Fax

Practice location:
  • Phone: 757-606-0531
  • Fax: 866-266-0815
Mailing address:
  • Phone: 757-606-0531
  • Fax: 866-266-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30001468
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009589
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: