Provider Demographics
NPI:1285993816
Name:SMITH, LORI LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65611 E BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-8226
Mailing Address - Country:US
Mailing Address - Phone:541-404-6807
Mailing Address - Fax:
Practice Address - Street 1:65611 E BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-8226
Practice Address - Country:US
Practice Address - Phone:541-404-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist