Provider Demographics
NPI:1912044819
Name:DAILEY, LORI JEAN (MD CCCA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 23RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2393
Mailing Address - Country:US
Mailing Address - Phone:402-721-8960
Mailing Address - Fax:402-727-9574
Practice Address - Street 1:415 E 23RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2393
Practice Address - Country:US
Practice Address - Phone:402-721-8960
Practice Address - Fax:402-727-9574
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06613OtherBCBS
275084Medicare ID - Type Unspecified