Provider Demographics
NPI:1871838524
Name:BLACK, LORRIE
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 SIMPSON FERRY RD
Mailing Address - Street 2:STE 202
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-6405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 MARKET ST
Practice Address - Street 2:STE 109
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1581
Practice Address - Country:US
Practice Address - Phone:717-972-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF0346000237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist