Provider Demographics
NPI:1851557441
Name:LEWIS, LORI ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELIZABETH
Last Name:LEWIS
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 1:6007 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7634
Mailing Address - Country:US
Mailing Address - Phone:417-581-6911
Mailing Address - Fax:417-581-6901
Practice Address - Street 1:6007 N 21ST ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7634
Practice Address - Country:US
Practice Address - Phone:417-581-6911
Practice Address - Fax:417-581-6901
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-02
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist