Provider Demographics
NPI:1730347741
Name:BEAULIEU, LAUREN LOUISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LOUISE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W 500 S
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-5957
Mailing Address - Country:US
Mailing Address - Phone:208-324-7117
Mailing Address - Fax:
Practice Address - Street 1:34 W 500 S
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-5957
Practice Address - Country:US
Practice Address - Phone:208-324-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808103800Medicaid
IDSP051OtherBLUE CROSS OF IDAHO