Provider Demographics
NPI:1376739573
Name:DIETZ, LORI B (SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:DIETZ
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 1:2265 HARRODSBURG RD
Mailing Address - Street 2:STE 350
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3500
Mailing Address - Country:US
Mailing Address - Phone:859-278-2121
Mailing Address - Fax:859-276-1649
Practice Address - Street 1:2265 HARRODSBURG RD
Practice Address - Street 2:STE 350
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3500
Practice Address - Country:US
Practice Address - Phone:859-278-2121
Practice Address - Fax:859-276-1649
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist