Provider Demographics
NPI:1154684082
Name:SHEA, LORI ANN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:SHEA
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 1:1927 NIGHTWALK CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1821
Mailing Address - Country:US
Mailing Address - Phone:615-691-0006
Mailing Address - Fax:
Practice Address - Street 1:1927 NIGHTWALK COURT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1821
Practice Address - Country:US
Practice Address - Phone:615-691-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist