Provider Demographics
NPI:1861053399
Name:TAGGART, LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:TAGGART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S 24TH ST APT 342
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6986
Mailing Address - Country:US
Mailing Address - Phone:480-299-3831
Mailing Address - Fax:
Practice Address - Street 1:108 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5818
Practice Address - Country:US
Practice Address - Phone:480-668-1917
Practice Address - Fax:480-668-2750
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9092235Z00000X
AZSLP12717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ083512Medicaid