Provider Demographics
NPI:1346348349
Name:KAY, LORI KATHLEEN (MA CCCA FAAA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KATHLEEN
Last Name:KAY
Suffix:
Gender:F
Credentials:MA CCCA FAAA
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:KATHLEEN
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCA FAAA
Mailing Address - Street 1:7920 WYOMING BLVD NE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6020
Mailing Address - Country:US
Mailing Address - Phone:505-821-6715
Mailing Address - Fax:505-821-0839
Practice Address - Street 1:5800 CAMP BOWIE BLVD
Practice Address - Street 2:STE 126
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5057
Practice Address - Country:US
Practice Address - Phone:817-870-2500
Practice Address - Fax:817-870-1382
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3138237600000X
TX80276231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48122831Medicaid