Provider Demographics
NPI:1679840441
Name:SMOLIN, LORI KAY (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:KAY
Last Name:SMOLIN
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E. THIRD AVENUE
Mailing Address - Street 2:MARY G. CLARKSON ELEMENTARY SCHOOL
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4221
Mailing Address - Country:US
Mailing Address - Phone:631-968-1205
Mailing Address - Fax:631-968-2461
Practice Address - Street 1:1415 E. THIRD AVENUE
Practice Address - Street 2:MARY G. CLARKSON ELEMENTARY SCHOOL
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4221
Practice Address - Country:US
Practice Address - Phone:631-968-1205
Practice Address - Fax:631-968-2461
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist