Provider Demographics
NPI:1003069659
Name:BUSSENGER, LORRI-ANNE KILEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORRI-ANNE
Middle Name:KILEY
Last Name:BUSSENGER
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 1:1 ADLER DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1223
Mailing Address - Country:US
Mailing Address - Phone:315-701-7900
Mailing Address - Fax:315-701-7901
Practice Address - Street 1:2100 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2785
Practice Address - Country:US
Practice Address - Phone:585-697-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011919-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist