Provider Demographics
NPI:1104283845
Name:BARNARD, LORI (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BARNARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 RAWHIDE DR
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-7286
Mailing Address - Country:US
Mailing Address - Phone:386-290-7626
Mailing Address - Fax:
Practice Address - Street 1:10 CYPRESS POINT CT
Practice Address - Street 2:(PINE TRAILS SUBDIVISION)
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8771
Practice Address - Country:US
Practice Address - Phone:386-290-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15177235Z00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program