Provider Demographics
NPI:1447757075
Name:MILLER, LORI KATHERINE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KATHERINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-2198
Mailing Address - Country:US
Mailing Address - Phone:719-254-3314
Mailing Address - Fax:719-254-7007
Practice Address - Street 1:900 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-2128
Practice Address - Country:US
Practice Address - Phone:719-254-3314
Practice Address - Fax:719-254-7007
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1346697471Medicaid