MEDICARE: LAUREN TADLOCK

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	11152	OH

General Provider Information

NPI Number	:	1043602709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN TADLOCK

Provider Business Mailing Address
First Line	:	3205 PARK ST
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3215
Country	:	US
Telephone Number	:	614-801-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 PARK ST
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3215
Country	:	US
Telephone Number	:	614-801-8800
Fax Number	:

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

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2015

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Directions to “ LAUREN TADLOCK ” Practice Location

Language	Start Address	Practice Location

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