Provider Demographics
NPI:1477694131
Name:WEILAND, LORI LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEE
Last Name:WEILAND
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 1:890 POTOSI ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3303
Mailing Address - Country:US
Mailing Address - Phone:573-701-0063
Mailing Address - Fax:573-701-1399
Practice Address - Street 1:284 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1610
Practice Address - Country:US
Practice Address - Phone:573-883-8181
Practice Address - Fax:573-883-8182
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist