Provider Demographics
NPI:1659119188
Name:BERRY, LAUREN (SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:792 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9681
Mailing Address - Country:US
Mailing Address - Phone:601-405-5394
Mailing Address - Fax:
Practice Address - Street 1:500 SILVER CROSS DR STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2304
Practice Address - Country:US
Practice Address - Phone:601-757-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-4607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist