Provider Demographics
NPI:1679864011
Name:ENOS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ENOS
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 1:5 EDGEWATER LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9035
Mailing Address - Country:US
Mailing Address - Phone:479-877-9550
Mailing Address - Fax:
Practice Address - Street 1:2301 W WALNUT ST
Practice Address - Street 2:SUITE 8-10
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3586
Practice Address - Country:US
Practice Address - Phone:479-631-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist