Basic Information
Provider Information
NPI: 1255780110
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: LAUREN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.S. , CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 NE LOOP 820
Address2: BUSINESS TOWER 1, SUITE 200
City: HURST
State: TX
PostalCode: 76053
CountryCode: US
TelephoneNumber: 8172928787
FaxNumber: 8177896849
Practice Location
Address1: 6601 MONTANA AVE STE G&H
Address2:  
City: EL PASO
State: TX
PostalCode: 799252155
CountryCode: US
TelephoneNumber: 9158387604
FaxNumber: 9157724633
Other Information
ProviderEnumerationDate: 06/10/2016
LastUpdateDate: 08/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X118829TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home