Provider Demographics
NPI:1518094390
Name:KING, LORI K (MA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:K
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-0263
Mailing Address - Country:US
Mailing Address - Phone:317-694-0685
Mailing Address - Fax:317-482-0073
Practice Address - Street 1:11010 HARBOR BAY DRIVE
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040
Practice Address - Country:US
Practice Address - Phone:317-694-0685
Practice Address - Fax:317-482-0073
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003208A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist