Provider Demographics
NPI:1619546801
Name:SULLIVAN, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SULLIVAN
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 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:814-231-7100
Mailing Address - Fax:814-238-0790
Practice Address - Street 1:164 GREENVIEW DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2106
Practice Address - Country:US
Practice Address - Phone:814-466-6396
Practice Address - Fax:814-466-6056
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001835231H00000X
PAAT006988231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist