MEDICARE: MRS. LORRAINE MARY PARKER MA,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00229000	NJ

General Provider Information

NPI Number	:	1134467327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORRAINE MARY PARKER MA,CCC-SLP

Provider Business Mailing Address
First Line	:	2430 EMERSON AVE
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2408
Country	:	US
Telephone Number	:	732-974-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	3349 HIGHWAY 138
Second Line	:	BUILDING B, SUITE A
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9671
Country	:	US
Telephone Number	:	732-280-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	01/22/2013

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