Healthcare Provider Details

I. General information

NPI: 1801100029
Provider Name (Legal Business Name): LORI L. HABONY NON-BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

919 2ND ST NE
CANTON OH
44704-1132
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7917
  • Fax: 330-452-8860
Mailing address:
  • Phone: 330-454-7917
  • Fax: 330-452-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: