Provider Demographics
NPI:1902887961
Name:STOKLOSA, LAUREN LANE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:LANE
Last Name:STOKLOSA
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LELAND FERRELL DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4559
Mailing Address - Country:US
Mailing Address - Phone:229-446-0692
Mailing Address - Fax:229-446-0692
Practice Address - Street 1:155 LELAND FERRELL DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4559
Practice Address - Country:US
Practice Address - Phone:229-446-0692
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA624173876AMedicaid