Provider Demographics
NPI:1043445307
Name:GUILLORY, LANORE LAVERN (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LANORE
Middle Name:LAVERN
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3380
Mailing Address - Country:US
Mailing Address - Phone:563-243-4159
Mailing Address - Fax:
Practice Address - Street 1:2713 N 13TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3380
Practice Address - Country:US
Practice Address - Phone:563-243-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist