Provider Demographics
NPI:1750301156
Name:SORIANO, LOURDES (SLP)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:125 CREEKVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7229
Mailing Address - Country:US
Mailing Address - Phone:706-575-0118
Mailing Address - Fax:866-464-6131
Practice Address - Street 1:125 CREEKVIEW TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7229
Practice Address - Country:US
Practice Address - Phone:706-575-0118
Practice Address - Fax:866-464-6131
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist