Healthcare Provider Details

I. General information

NPI: 1699831081
Provider Name (Legal Business Name): LORI ANN EGGERS M.A.,CCC/SLPCERT AVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONDIT CT
ROSELAND NJ
07068-1313
US

IV. Provider business mailing address

10 CONDIT CT
ROSELAND NJ
07068-1313
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-8089
  • Fax:
Mailing address:
  • Phone: 973-226-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberYS002997
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: