Provider Demographics
NPI:1033979158
Name:DONNELLY, LORI F
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:F
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ROUTE 22 WEST
Mailing Address - Street 2:STE 30 #1021
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069
Mailing Address - Country:US
Mailing Address - Phone:908-248-2278
Mailing Address - Fax:
Practice Address - Street 1:1515 ROUTE 22 W # 1021
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6509
Practice Address - Country:US
Practice Address - Phone:908-248-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00364400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist