Basic Information
| Provider Information | |||||||||
| NPI: | 1811272164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARLEY | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3225 W HARBOR VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336111920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132634765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4443 ROWAN ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278469900 | ||||||||
| FaxNumber: | 7278345419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ5659 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.