Healthcare Provider Details

I. General information

NPI: 1508278698
Provider Name (Legal Business Name): LORI KALLANXHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W KORTSEN RD STE 202
CASA GRANDE AZ
85122-5923
US

IV. Provider business mailing address

41750 W BARCELONA DR
MARICOPA AZ
85138-4445
US

V. Phone/Fax

Practice location:
  • Phone: 520-424-1102
  • Fax: 520-413-5787
Mailing address:
  • Phone: 520-424-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA8851
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: