Provider Demographics
NPI:1114642105
Name:STEVENS, LORI BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:STEVENS
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 1:2396 WITT RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-6926
Mailing Address - Country:US
Mailing Address - Phone:909-913-2853
Mailing Address - Fax:
Practice Address - Street 1:2396 WITT RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-6926
Practice Address - Country:US
Practice Address - Phone:909-913-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY140524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist