MEDICARE: MRS. LORI SUE BREWER M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP#2235	AR

General Provider Information

NPI Number	:	1851340376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI SUE BREWER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 144
Second Line	:
City	:	KANSAS
State	:	OK
Zip	:	74347-0144
Country	:	US
Telephone Number	:	918-868-7360
Fax Number	:

Provider Business Practice Location Address
First Line	:	53769 S 620 RD
Second Line	:
City	:	KANSAS
State	:	OK
Zip	:	74347-1287
Country	:	US
Telephone Number	:	918-868-7360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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