Provider Demographics
NPI:1508118712
Name:WADE, LORI MCCOMBS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MCCOMBS
Last Name:WADE
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 1:149 GLEN BROOKE LANE
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-9328
Mailing Address - Country:US
Mailing Address - Phone:336-416-2069
Mailing Address - Fax:
Practice Address - Street 1:149 GLEN BROOKE LANE
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9328
Practice Address - Country:US
Practice Address - Phone:336-416-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist