MEDICARE: LAUREN CLARK SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		DC
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1043372758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CLARK SLP

Provider Business Mailing Address
First Line	:	3808 SURRY RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1624
Country	:	US
Telephone Number	:	410-713-0176
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 SURRY RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1624
Country	:	US
Telephone Number	:	410-713-0176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	09/04/2020

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Directions to “ LAUREN CLARK SLP” Practice Location

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