MEDICARE: LAUREN CANTRELL

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

General Provider Information

NPI Number	:	1215604913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CANTRELL

Provider Business Mailing Address
First Line	:	8419 E VIRGINIA AVE
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-1821
Country	:	US
Telephone Number	:	480-415-3562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 E VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1324
Country	:	US
Telephone Number	:	602-381-6120
Fax Number	:

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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Directions to “ LAUREN CANTRELL ” Practice Location

Language	Start Address	Practice Location

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