Provider Demographics
NPI:1659521573
Name:BANGHART, LORI (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BANGHART
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 1:8119 WILLOW BEND CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5017
Mailing Address - Country:US
Mailing Address - Phone:303-888-5974
Mailing Address - Fax:
Practice Address - Street 1:8119 WILLOW BEND CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5017
Practice Address - Country:US
Practice Address - Phone:303-888-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12017099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist