Healthcare Provider Details

I. General information

NPI: 1760736862
Provider Name (Legal Business Name): LORI DICK MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 PARK LN
SCIENCE HILL KY
42553-9437
US

IV. Provider business mailing address

156 PARK LN
SCIENCE HILL KY
42553-9437
US

V. Phone/Fax

Practice location:
  • Phone: 606-305-3374
  • Fax:
Mailing address:
  • Phone: 606-305-3374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1108
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: