MEDICARE: LAUREN LARRAURI

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	SLP009106	GA

General Provider Information

NPI Number	:	1578928073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LARRAURI

Provider Business Mailing Address
First Line	:	225 WES PARK DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-4829
Country	:	US
Telephone Number	:	478-987-1610
Fax Number	:	973-965-4580

Provider Business Practice Location Address
First Line	:	225 WES PARK DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-4829
Country	:	US
Telephone Number	:	478-987-1610
Fax Number	:	973-965-4580

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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Directions to “ LAUREN LARRAURI ” Practice Location

Language	Start Address	Practice Location

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