Provider Demographics
NPI:1457774457
Name:TEMPLES, LORI PHILLIPS
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:PHILLIPS
Last Name:TEMPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S. WEST ST.
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817
Mailing Address - Country:US
Mailing Address - Phone:229-248-2837
Mailing Address - Fax:229-248-2844
Practice Address - Street 1:100 S. WEST ST.
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817
Practice Address - Country:US
Practice Address - Phone:229-248-2837
Practice Address - Fax:229-248-2844
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist