Provider Demographics
NPI:1134385024
Name:FREDERICK, LORI SUSANNE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SUSANNE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4730
Mailing Address - Country:US
Mailing Address - Phone:901-842-4327
Mailing Address - Fax:901-842-4330
Practice Address - Street 1:6242 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4730
Practice Address - Country:US
Practice Address - Phone:901-842-4327
Practice Address - Fax:901-842-4330
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001325237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter