Provider Demographics
NPI:1467889915
Name:WILLMAN, LORI K SR (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:K
Last Name:WILLMAN
Suffix:SR
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1864
Mailing Address - Country:US
Mailing Address - Phone:585-248-6391
Mailing Address - Fax:585-248-6318
Practice Address - Street 1:400 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1864
Practice Address - Country:US
Practice Address - Phone:585-248-6391
Practice Address - Fax:585-248-6318
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235Z00000XOtherPROVIDER TAXONOMY