Provider Demographics
NPI:1902232101
Name:GODBY, LAUREN MICHELE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELE
Last Name:GODBY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 PRESCOTT AVE APT D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2331
Mailing Address - Country:US
Mailing Address - Phone:214-683-0259
Mailing Address - Fax:
Practice Address - Street 1:4210 PRESCOTT AVE APT D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2331
Practice Address - Country:US
Practice Address - Phone:214-683-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist