Provider Demographics
NPI:1932500501
Name:SHAFFER, LORI (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3603
Mailing Address - Country:US
Mailing Address - Phone:313-732-1461
Mailing Address - Fax:313-347-1652
Practice Address - Street 1:23936 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1833
Practice Address - Country:US
Practice Address - Phone:313-278-4601
Practice Address - Fax:313-347-1652
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist