Provider Demographics
NPI:1851582167
Name:ALLEN, LORI MCCULLOUGH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MCCULLOUGH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9881 INVENTION LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8191
Mailing Address - Country:US
Mailing Address - Phone:904-465-0178
Mailing Address - Fax:904-770-5596
Practice Address - Street 1:9881 INVENTION LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8191
Practice Address - Country:US
Practice Address - Phone:904-465-0178
Practice Address - Fax:904-770-5596
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLSA5457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811205300Medicaid
FL892340000Medicaid