Provider Demographics
NPI:1174857304
Name:CONSOLI, LORRAINE E (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:E
Last Name:CONSOLI
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 97
Mailing Address - Street 2:
Mailing Address - City:ACRA
Mailing Address - State:NY
Mailing Address - Zip Code:12405-0097
Mailing Address - Country:US
Mailing Address - Phone:518-622-2929
Mailing Address - Fax:518-622-2929
Practice Address - Street 1:37 BAILEY RD
Practice Address - Street 2:
Practice Address - City:PURLING
Practice Address - State:NY
Practice Address - Zip Code:12470-3527
Practice Address - Country:US
Practice Address - Phone:518-622-2929
Practice Address - Fax:518-622-2929
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013561-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist