Healthcare Provider Details

I. General information

NPI: 1003746082
Provider Name (Legal Business Name): LORI MAIDEN ROACH M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 AUSTIN ST
ALBEMARLE NC
28001-3206
US

IV. Provider business mailing address

2230 SNUGGS PARK RD
ALBEMARLE NC
28001-8509
US

V. Phone/Fax

Practice location:
  • Phone: 980-581-1479
  • Fax:
Mailing address:
  • Phone: 980-581-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4442
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: