Provider Demographics
NPI:1295952067
Name:MATHIEU, LORI E (AUD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:MATHIEU
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-0790
Mailing Address - Country:US
Mailing Address - Phone:518-891-7617
Mailing Address - Fax:
Practice Address - Street 1:11 HAMMOND LN
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2003
Practice Address - Country:US
Practice Address - Phone:518-562-0054
Practice Address - Fax:518-563-5518
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001213-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist