Healthcare Provider Details

I. General information

NPI: 1700955283
Provider Name (Legal Business Name): LORI K. LINGO M. ED., CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GENOA BUSINESS PARK DR
BRIGHTON MI
48114-7367
US

IV. Provider business mailing address

2300 GENOA BUSINESS PARK DR
BRIGHTON MI
48114-7367
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-2205
  • Fax:
Mailing address:
  • Phone: 810-225-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3501002654
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000209
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number1601000209
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number1601000209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: