Provider Demographics
NPI:1336763010
Name:POORMAN, LORI BENNETT (ASHA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BENNETT
Last Name:POORMAN
Suffix:
Gender:F
Credentials:ASHA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 HERMITAGE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1550
Mailing Address - Country:US
Mailing Address - Phone:706-936-1561
Mailing Address - Fax:
Practice Address - Street 1:751 HERMITAGE TRAIL DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1550
Practice Address - Country:US
Practice Address - Phone:706-936-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP28119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist