Provider Demographics
NPI:1700298593
Name:STADING, LORI BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:STADING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:KOSTREWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:22178 E. VIA DEL ORO
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142
Mailing Address - Country:US
Mailing Address - Phone:847-217-4773
Mailing Address - Fax:
Practice Address - Street 1:7540 N. 19TH AVE SUITE 200
Practice Address - Street 2:SYNERTX REHAB
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:888-543-2289
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 4103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist