Provider Demographics
NPI:1437307238
Name:LOREK, JENNIFER (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOREK
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 1:18959 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9477
Mailing Address - Country:US
Mailing Address - Phone:503-563-5438
Mailing Address - Fax:503-563-5281
Practice Address - Street 1:18959 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9477
Practice Address - Country:US
Practice Address - Phone:503-563-5438
Practice Address - Fax:503-563-5281
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17042235Z00000X
WALL60197767235Z00000X
OR13400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist