Provider Demographics
NPI:1679084636
Name:FILLMAN, LORI ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:FILLMAN
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 1:19 TOBY LANE
Mailing Address - Street 2:
Mailing Address - City:YARDVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08620
Mailing Address - Country:US
Mailing Address - Phone:609-306-6023
Mailing Address - Fax:
Practice Address - Street 1:19 TOBY LN
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-2603
Practice Address - Country:US
Practice Address - Phone:609-306-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00740500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist