Provider Demographics
NPI:1043651292
Name:PORCELLI, LORI A (MS, CCC-SLP, IBCLC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:MS, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 403
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1710
Mailing Address - Country:US
Mailing Address - Phone:917-414-9429
Mailing Address - Fax:
Practice Address - Street 1:447 TENNESSEE AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5433
Practice Address - Country:US
Practice Address - Phone:202-998-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07273235Z00000X
DCSLP000685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist