Provider Demographics
NPI:1083290241
Name:WILEY, LORI (AUD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:AUD, PHD
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 701400
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-1400
Mailing Address - Country:US
Mailing Address - Phone:808-676-1893
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE STE 232
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3962
Practice Address - Country:US
Practice Address - Phone:808-676-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD-76231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist