Provider Demographics
NPI:1619446333
Name:ZAVOYNA, LORI MILDRE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MILDRE
Last Name:ZAVOYNA
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 1:2307 WILLOUGHBY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3419
Mailing Address - Country:US
Mailing Address - Phone:410-612-1535
Mailing Address - Fax:410-612-1573
Practice Address - Street 1:2307 WILLOUGHBY BEACH RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3419
Practice Address - Country:US
Practice Address - Phone:410-612-1535
Practice Address - Fax:410-612-1573
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD07058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist