Provider Demographics
NPI:1083196810
Name:DAVIS, LORI A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:DAVIS
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:PO BOX 2459
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6200
Mailing Address - Country:US
Mailing Address - Phone:662-380-5030
Mailing Address - Fax:662-297-7598
Practice Address - Street 1:169 HIGHWAY 6 E STE 102
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6902
Practice Address - Country:US
Practice Address - Phone:662-380-5030
Practice Address - Fax:662-297-7598
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist