Provider Demographics
NPI:1922120906
Name:WARMA, LORI (MACCC -SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WARMA
Suffix:
Gender:F
Credentials:MACCC -SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2729
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-2729
Mailing Address - Country:US
Mailing Address - Phone:406-452-4660
Mailing Address - Fax:406-452-4880
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:SUITE 550
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-452-4660
Practice Address - Fax:406-452-4880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT661510OtherBLUECROSSBLUESHIELD #
MT0533664Medicaid