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General NPI Number Information
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NPI Number | 1164240222
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Entity Type | Individual
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Provider Name | LAUREN MELISSA PARK M.A. SLP-CCC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 870 N MOUNTAIN AVE STE 118
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City | UPLAND
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State | CA
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Zip | 91786-4173
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Country | US
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Telephone | 909-278-7042
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Fax | 909-575-6209
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Provider Business Mailing Address
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Address Line | 7922 DAY CREEK BLVD APT 4302
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8590
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Country | US
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Telephone | 330-473-8105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22009233A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 39936
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License Number State | CA
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