Provider Demographics
NPI:1760296149
Name:CARR, LAUREN GRACE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:GRACE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-9736
Mailing Address - Country:US
Mailing Address - Phone:518-894-6497
Mailing Address - Fax:
Practice Address - Street 1:112 OLD JOHNSTOWN RD
Practice Address - Street 2:PO BOX 1051
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068
Practice Address - Country:US
Practice Address - Phone:518-853-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist