Provider Demographics
NPI:1730857061
Name:MOEDE, LAUREN H (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:H
Last Name:MOEDE
Suffix:
Gender:M
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 1:11428 SABINAL MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-4383
Mailing Address - Country:US
Mailing Address - Phone:512-413-7019
Mailing Address - Fax:
Practice Address - Street 1:11428 SABINAL MESA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-4383
Practice Address - Country:US
Practice Address - Phone:512-413-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist