Provider Demographics
NPI:1194282376
Name:HYDE, LORI ANN
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S SHILOH AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MO
Mailing Address - Zip Code:65632-8238
Mailing Address - Country:US
Mailing Address - Phone:417-589-2171
Mailing Address - Fax:
Practice Address - Street 1:209 S SHILOH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MO
Practice Address - Zip Code:65632-8238
Practice Address - Country:US
Practice Address - Phone:417-589-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist