Provider Demographics
NPI:1306720511
Name:BAGWELL, LORI ANNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ANNE
Other - Last Name:MCWHORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1616 LUCY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-7633
Mailing Address - Country:US
Mailing Address - Phone:229-942-6797
Mailing Address - Fax:
Practice Address - Street 1:100 W UNION ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1055
Practice Address - Country:US
Practice Address - Phone:229-521-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist