Provider Demographics
NPI:1558894824
Name:KENNEMER, LORI
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:KENNEMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20250 E 1280 RD
Mailing Address - Street 2:
Mailing Address - City:CARTER
Mailing Address - State:OK
Mailing Address - Zip Code:73627-2725
Mailing Address - Country:US
Mailing Address - Phone:580-799-1255
Mailing Address - Fax:580-928-3936
Practice Address - Street 1:20250 E 1280 RD
Practice Address - Street 2:
Practice Address - City:CARTER
Practice Address - State:OK
Practice Address - Zip Code:73627-2725
Practice Address - Country:US
Practice Address - Phone:580-799-1255
Practice Address - Fax:580-928-3936
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist