Provider Demographics
NPI:1467677625
Name:TINKER, LORRIE GAY (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:GAY
Last Name:TINKER
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 CANTRELL ST.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521
Mailing Address - Country:US
Mailing Address - Phone:217-320-3613
Mailing Address - Fax:
Practice Address - Street 1:444 W HARRISON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-877-7333
Practice Address - Fax:217-872-6723
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005582235Z00000X
TX102810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist