Individual provider Active NPI

Lauren Melissa Park, M.A. SLP-CCC

  • Speech-Language Pathologist
  • Upland, CA
National Provider Identifier
1164240222
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
39936 Issued in CA
Practice address
870 N Mountain Ave Ste 118
Upland, CA 91786-4173
Phone
(909) 278-7042
Fax
(909) 575-6209
NPI assigned
Sep 27, 2024
Last updated
Jul 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 22009233A IN
Speech-Language Pathologist 235Z00000X 39936 CA Primary

Addresses

Primary practice location

870 N Mountain Ave Ste 118
Upland, CA 91786-4173

Mailing address

7922 Day Creek Blvd Apt 4302
Rancho Cucamonga, CA 91739-8590
Phone (330) 473-8105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
39936CAMDGeneral Practice Dentistry
22009233AINMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
King Speech Therapy Services PC Speech-Language Pathologist CurrentSince Jul 22, 2025 Accepting new patients

Locations

870 N Mountain Ave
Ste 118
Upland, CA 91786
Phone (909) 278-7042

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1164240222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7922 DAY CREEK BLVD APT 4302",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917398590",
            "telephone_number": "330-473-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 N MOUNTAIN AVE STE 118",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864173",
            "telephone_number": "909-278-7042",
            "fax_number": "909-575-6209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "LAUREN",
        "middle_name": "MELISSA",
        "name_prefix": "Ms.",
        "credential": "M.A. SLP-CCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-27",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22009233A",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "39936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.