Provider Demographics
NPI:1780049668
Name:JEFFERSON, LOREE (MS-SLP-CFY)
Entity type:Individual
Prefix:MISS
First Name:LOREE
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MS-SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E PEARL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-4200
Mailing Address - Country:US
Mailing Address - Phone:361-645-8229
Mailing Address - Fax:
Practice Address - Street 1:314 E PEARL ST STE 4
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963-4200
Practice Address - Country:US
Practice Address - Phone:361-645-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist