Provider Demographics
NPI:1255457511
Name:ODEN, LORIN STAR (AUD)
Entity type:Individual
Prefix:DR
First Name:LORIN
Middle Name:STAR
Last Name:ODEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 JAKE ALEXANDER BLVD WEST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1365
Mailing Address - Country:US
Mailing Address - Phone:704-633-0023
Mailing Address - Fax:704-705-2363
Practice Address - Street 1:464 JAKE ALEXANDER BLVD WEST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1365
Practice Address - Country:US
Practice Address - Phone:704-633-0023
Practice Address - Fax:704-705-2363
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2194231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413628Medicaid
NC3404261Medicaid