MEDICARE: DR. LAUREN GONGRE MILEY CLINSCD, CCC-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

General Provider Information

NPI Number	:	1578064978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN GONGRE MILEY CLINSCD, CCC-SLP

Provider Business Mailing Address
First Line	:	9862 LOBLOLLY PINES LN
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5836
Country	:	US
Telephone Number	:	225-603-6230
Fax Number	:

Provider Business Practice Location Address
First Line	:	9862 LOBLOLLY PINES LN
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5836
Country	:	US
Telephone Number	:	225-603-6230
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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Directions to “ DR. LAUREN GONGRE MILEY CLINSCD, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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