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General NPI Number Information
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NPI Number | 1518094390
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Entity Type | Individual
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Provider Name | LORI K KING MA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11010 HARBOR BAY DRIVE
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City | FORTVILLE
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State | IN
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Zip | 46040
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Country | US
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Telephone | 317-694-0685
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Fax | 317-482-0073
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Provider Business Mailing Address
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Address Line | PO BOX 263
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City | MC CORDSVILLE
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State | IN
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Zip | 46055-0263
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Country | US
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Telephone | 317-694-0685
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Fax | 317-482-0073
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22003208A
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License Number State | IN
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