MEDICARE: MS. LORI RENEE TEIGEN 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	SA9361	FL
2	235Z00000X	Speech-Language Pathologist		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA9361	OTHER	FL	SPEECH LANGUAGE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588861546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI RENEE TEIGEN CCC-SLP

Provider Business Mailing Address
First Line	:	600 GREIG TRL
Second Line	:
City	:	STOUGHTON
State	:	WI
Zip	:	53589-1185
Country	:	US
Telephone Number	:	352-620-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W GREEN TREE RD
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1055
Country	:	US
Telephone Number	:	352-620-5999
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	06/01/2026

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