MEDICARE: LAUREN ELLISH 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	:	1992179550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELLISH CCC-SLP

Provider Business Mailing Address
First Line	:	2233 W CALLE MARITA
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7061
Country	:	US
Telephone Number	:	480-444-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 W CALLE MARITA
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7061
Country	:	US
Telephone Number	:	480-444-9345
Fax Number	:

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

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	04/02/2024

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Directions to “ LAUREN ELLISH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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