MEDICARE: MRS. LORI ALICIA DAVIS 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	P8318	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144539230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ALICIA DAVIS SLP

Provider Business Mailing Address
First Line	:	149 WOODLAND DR
Second Line	:
City	:	JUNCTION CITY
State	:	AR
Zip	:	71749-9505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 WOODLAND DR
Second Line	:
City	:	JUNCTION CITY
State	:	AR
Zip	:	71749-9505
Country	:	US
Telephone Number	:	870-310-4668
Fax Number	:

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	10/06/2010

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