Provider Demographics
NPI:1508759101
Name:WILLS, LORI BRAZELL (EDS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BRAZELL
Last Name:WILLS
Suffix:
Gender:F
Credentials:EDS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 MACK DOBBS RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3266
Mailing Address - Country:US
Mailing Address - Phone:404-863-6231
Mailing Address - Fax:
Practice Address - Street 1:5150 STILESBORO RD NW STE 210
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7742
Practice Address - Country:US
Practice Address - Phone:404-273-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist