MEDICARE: LORI LADY LCSW

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	1041C0700X	Clinical Social Worker	2026009286	MO

General Provider Information

NPI Number	:	1518724566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LADY LCSW

Provider Business Mailing Address
First Line	:	936 IDA ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-4210
Country	:	US
Telephone Number	:	573-300-4597
Fax Number	:	573-300-4612

Provider Business Practice Location Address
First Line	:	936 IDA ST
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-4210
Country	:	US
Telephone Number	:	573-300-4597
Fax Number	:	573-300-4612

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

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	05/27/2026

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