Provider Demographics
NPI:1700058336
Name:TRAVIS, LORI S (AUD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:TRAVIS
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 1:588 CLOVER LN
Mailing Address - Street 2:UNIT C
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2989
Mailing Address - Country:US
Mailing Address - Phone:573-645-2035
Mailing Address - Fax:
Practice Address - Street 1:906 WOODLAND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2752
Practice Address - Country:US
Practice Address - Phone:270-765-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20007013693231H00000X
KY0495231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist