Provider Demographics
NPI:1861997488
Name:PADULA, LAUREN R
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:R
Last Name:PADULA
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 1:925 S BLACK HORSE PIKE # B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1900
Mailing Address - Country:US
Mailing Address - Phone:856-236-7781
Mailing Address - Fax:
Practice Address - Street 1:925 S BLACK HORSE PIKE # B
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1900
Practice Address - Country:US
Practice Address - Phone:856-236-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJATP86011225CA2400X
NJ41YS00849800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner