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General NPI Number Information
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NPI Number | 1174783021
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Entity Type | Individual
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Provider Name | LORI M. ROSES AUD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 3495 IRON HORSE RD STE B
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City | LADSON
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State | SC
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Zip | 29456-4319
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Country | US
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Telephone | 843-258-5060
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Fax | 843-492-4712
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Provider Business Mailing Address
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Address Line | PO BOX 530062
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City | ATLANTA
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State | GA
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Zip | 30353-0062
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Country | US
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Telephone | 843-695-6071
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Fax | 843-569-5881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 41YA00058800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 25MG00091600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 4104
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License Number State | SC
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