Provider Demographics
NPI:1881719409
Name:THOMPSON, LORI KAYE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16225 FOX CROSS DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6615
Mailing Address - Country:US
Mailing Address - Phone:574-271-0258
Mailing Address - Fax:775-205-7927
Practice Address - Street 1:16225 FOX CROSS DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6615
Practice Address - Country:US
Practice Address - Phone:574-271-0258
Practice Address - Fax:775-205-7927
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002213A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist