Provider Demographics
NPI:1235464371
Name:KLEIN, LORI M (SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:KLEIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7108
Mailing Address - Country:US
Mailing Address - Phone:253-854-5660
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:750 IMPERIAL ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5309
Practice Address - Country:US
Practice Address - Phone:540-382-5114
Practice Address - Fax:540-394-4448
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60032020235Z00000X
VA2202007875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018518Medicaid
WA600337984Medicare UPIN