Provider Demographics
NPI:1518990225
Name:ISELY, LORI ANN (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:ISELY
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:PENNARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 E PECAN
Mailing Address - Street 2:PO BOX 8190
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-8190
Mailing Address - Country:US
Mailing Address - Phone:580-482-4781
Mailing Address - Fax:580-481-2345
Practice Address - Street 1:1200 E PECAN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521
Practice Address - Country:US
Practice Address - Phone:580-482-4781
Practice Address - Fax:580-481-2345
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK338231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist