Individual
MS. LAUREN R STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3690
(904) 390-3502
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AZ504
FL
Other
Enumeration date
08/10/2006
Last updated
09/06/2011
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