Provider Demographics
NPI:1952516650
Name:KRAMER, LORI ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 WEST 1000 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639
Mailing Address - Country:US
Mailing Address - Phone:812-768-5324
Mailing Address - Fax:812-753-3572
Practice Address - Street 1:780 WEST 1000 SOUTH
Practice Address - Street 2:
Practice Address - City:HAUBSTADT
Practice Address - State:IN
Practice Address - Zip Code:47639
Practice Address - Country:US
Practice Address - Phone:812-768-5324
Practice Address - Fax:812-753-3572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002820A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200706020AMedicaid