Provider Demographics
NPI:1942036108
Name:GOULD, LAURYN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURYN
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:LAURYN
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 ANTIOCH CIR W
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9456
Mailing Address - Country:US
Mailing Address - Phone:618-240-1867
Mailing Address - Fax:
Practice Address - Street 1:1450 E CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5316
Practice Address - Country:US
Practice Address - Phone:820-981-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004341A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist