Provider Demographics
NPI:1760981401
Name:PERKINS, LORI OSBORNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:OSBORNE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 MONET DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5314
Mailing Address - Country:US
Mailing Address - Phone:540-580-2258
Mailing Address - Fax:
Practice Address - Street 1:3057 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4705
Practice Address - Country:US
Practice Address - Phone:540-853-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist