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General NPI Number Information
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NPI Number | 1740737907
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Entity Type | Individual
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Provider Name | MS. LAUREN KATHRYN MATHIEU
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Gender | Female
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3709 SHANNONS GREEN WAY
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City | ALEXANDRIA
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State | VA
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Zip | 22309-3659
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Country | US
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Telephone | 703-596-8786
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 FRANKLINS WAY
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City | OAK HILL
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State | VA
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Zip | 20171-1924
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Country | US
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Telephone | 703-785-9663
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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 | 2202008363
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License Number State | VA
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