Provider Demographics
NPI:1881142719
Name:LORENTZ, CARRIE (MA, SLP LICENSE)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:MA, SLP LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4883
Mailing Address - Country:US
Mailing Address - Phone:636-305-3499
Mailing Address - Fax:
Practice Address - Street 1:519 8TH ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-4232
Practice Address - Country:US
Practice Address - Phone:636-305-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist