Provider Demographics
NPI:1689337115
Name:SIMEONE, LORI MELISSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MELISSA
Last Name:SIMEONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FORMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3239
Mailing Address - Country:US
Mailing Address - Phone:732-580-2773
Mailing Address - Fax:
Practice Address - Street 1:2-12 CORBETT WAY STE 203
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4251
Practice Address - Country:US
Practice Address - Phone:732-544-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00474500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist