Provider Demographics
NPI:1578008207
Name:LORI M. KILPATRICK SPEECH AND FEEDING THERAPY
Entity type:Organization
Organization Name:LORI M. KILPATRICK SPEECH AND FEEDING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINICIPAL/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:228-861-4994
Mailing Address - Street 1:14013 SOLANO CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2557
Mailing Address - Country:US
Mailing Address - Phone:228-861-4994
Mailing Address - Fax:228-818-9167
Practice Address - Street 1:1706 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3073
Practice Address - Country:US
Practice Address - Phone:228-861-4994
Practice Address - Fax:228-818-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2888235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05220745Medicaid