Provider Demographics
NPI:1427202258
Name:SLACKMAN, LORI BETH
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:BETH
Last Name:SLACKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5017
Mailing Address - Country:US
Mailing Address - Phone:845-425-3054
Mailing Address - Fax:
Practice Address - Street 1:18 KEITH DRIVE
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-5017
Practice Address - Country:US
Practice Address - Phone:845-425-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014410-1235Z00000X
NJ536137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14410-1OtherSPEECH/LANGUAGE PATHOLOGIST
NJ536137OtherSPEECH/LANGUUAGE SPECIALIST