Provider Demographics
NPI:1982200192
Name:ANDERSON, LORI LYNN (HIS)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:1901 BEASER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3604
Mailing Address - Country:US
Mailing Address - Phone:715-682-9311
Mailing Address - Fax:715-682-9313
Practice Address - Street 1:1901 BEASER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3604
Practice Address - Country:US
Practice Address - Phone:715-682-9311
Practice Address - Fax:715-682-9313
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1626-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100141440Medicaid