Provider Demographics
NPI:1144864059
Name:LALLY, LAUREN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LALLY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LEIGH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2910 LEGACY POINTE WAY APT 221
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-2164
Mailing Address - Country:US
Mailing Address - Phone:276-698-6081
Mailing Address - Fax:
Practice Address - Street 1:400 HERRON RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1706
Practice Address - Country:US
Practice Address - Phone:276-698-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005634235Z00000X
SC7499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty