Provider Demographics
NPI:1265571624
Name:DESMOND, LORI P (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:P
Last Name:DESMOND
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:PARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9319 E FAIRBROOK ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-5268
Mailing Address - Country:US
Mailing Address - Phone:480-209-8243
Mailing Address - Fax:
Practice Address - Street 1:9319 E FAIRBROOK ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-5268
Practice Address - Country:US
Practice Address - Phone:480-209-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ897077Medicaid