MEDICARE: LAUREN WALSH M.A., CCC-SLP/TSSLD

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	961390	NY

General Provider Information

NPI Number	:	1073893798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WALSH M.A., CCC-SLP/TSSLD

Provider Business Mailing Address
First Line	:	15 CLOVEBROOK RD
Second Line	:
City	:	VALHALLA
State	:	NY
Zip	:	10595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 HILLMAN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-3001
Country	:	US
Telephone Number	:	718-796-9200
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	12/05/2016

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