MEDICARE: MS. LORI BETH GULLE M.S. 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	016228	NY

General Provider Information

NPI Number	:	1346382223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI BETH GULLE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	41 FREDERICK ST
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-3916
Country	:	US
Telephone Number	:	631-834-2043
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 FREDERICK ST
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-3916
Country	:	US
Telephone Number	:	631-834-2043
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/26/2009

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Directions to “ MS. LORI BETH GULLE M.S. CCC-SLP” Practice Location

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