Provider Demographics
NPI:1013073808
Name:MAENPAA, LORI (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MAENPAA
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 1:2455 CLINTWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4255
Mailing Address - Country:US
Mailing Address - Phone:678-315-3614
Mailing Address - Fax:
Practice Address - Street 1:2455 CLINTWOOD DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4255
Practice Address - Country:US
Practice Address - Phone:678-315-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA374454870AMedicaid