Provider Demographics
NPI:1487753919
Name:POWERS, LAUREN STREET (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:STREET
Last Name:POWERS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 WALNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6301
Mailing Address - Country:US
Mailing Address - Phone:901-309-5219
Mailing Address - Fax:901-309-5265
Practice Address - Street 1:751 WALNUT KNOLL LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6301
Practice Address - Country:US
Practice Address - Phone:901-309-5219
Practice Address - Fax:901-309-5265
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4120655OtherBCBS OF TN PIN