Provider Demographics
NPI:1215101993
Name:DONOVAN, LORI MICHELLE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MICHELLE
Last Name:DONOVAN
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 1:8065 ROCK OAK CIR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4153
Mailing Address - Country:US
Mailing Address - Phone:617-913-8969
Mailing Address - Fax:
Practice Address - Street 1:31320 INTERSTATE 10 W STE D
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5028
Practice Address - Country:US
Practice Address - Phone:830-755-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist