Lauren Kavanaugh-Wallace, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P-3786 Issued in NC

Practice address

18805 W Catawba Ave
Ste 207
Cornelius, NC 28031-4608

Phone

(704) 787-4272

Fax

(980) 321-7106

NPI assigned

Oct 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326412800000",
    "number": "1649459397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18805 W CATAWBA AVE STE 207",
            "address_2": "PO BOX 361",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314609",
            "telephone_number": "704-787-4272",
            "fax_number": "980-321-7106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18805 W CATAWBA AVE",
            "address_2": "STE 207",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314608",
            "telephone_number": "704-787-4272",
            "fax_number": "980-321-7106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAUGH-WALLACE",
        "first_name": "LAUREN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-30",
        "last_updated": "2012-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "P-3786",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "630101257",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011257",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005134",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Munson DDS MD PLLC
• Melisa Kalac, OD
• Alexandra Kamieniecki, MD
• Karen Kammann, OTR
• Kathleen McIntyre Coaching and Wellness
• Lucas Keane, DC
• Kenneth M. Schneider, Jr., D.D.S, P.a.
• Kenneth R. McGrath, D.D.S., P.a.
• Ashlyn Kerls, DPT
• Elaine Kerns, LCSW

• Psychologist in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.