Provider Demographics
NPI:1245639509
Name:PRINE, LORI (MA-CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:PRINE
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 1:10713 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45130-9617
Mailing Address - Country:US
Mailing Address - Phone:513-309-8859
Mailing Address - Fax:
Practice Address - Street 1:601 S APPLE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45118-8462
Practice Address - Country:US
Practice Address - Phone:513-875-2083
Practice Address - Fax:513-875-4511
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist