Provider Demographics
NPI:1952313413
Name:DODSON, LORA JANE (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:JANE
Last Name:DODSON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8154 GROTON LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2822
Mailing Address - Country:US
Mailing Address - Phone:317-418-1313
Mailing Address - Fax:
Practice Address - Street 1:11708 N COLLEGE AVE STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5708
Practice Address - Country:US
Practice Address - Phone:317-569-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004294A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200815770Medicaid