Provider Demographics
NPI:1730301102
Name:GOTT, LORI SUZANNE (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUZANNE
Last Name:GOTT
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 N OAK BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4410
Mailing Address - Country:US
Mailing Address - Phone:479-225-6041
Mailing Address - Fax:
Practice Address - Street 1:519 LATHAM DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-750-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSA 670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist