Provider Demographics
NPI:1386823144
Name:LOUGH, GEORGIA LEE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LEE
Last Name:LOUGH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SANGER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-9435
Mailing Address - Country:US
Mailing Address - Phone:724-843-2754
Mailing Address - Fax:
Practice Address - Street 1:138 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9714
Practice Address - Country:US
Practice Address - Phone:724-774-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003445L235Z00000X
OHSP4040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist