Provider Demographics
NPI:1184953507
Name:BURNS-GORECKI, LORI ELLEN (MA-CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:BURNS-GORECKI
Suffix:
Gender:F
Credentials:MA-CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2029
Mailing Address - Country:US
Mailing Address - Phone:708-213-3163
Mailing Address - Fax:708-213-0124
Practice Address - Street 1:17800 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2029
Practice Address - Country:US
Practice Address - Phone:708-213-3163
Practice Address - Fax:708-213-0124
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist