Provider Demographics
NPI:1386148609
Name:WEISSMAN, LORI MARY (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MARY
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MAY
Other - Last Name:SULICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:890 COMMONS WAY BLDG H
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6430
Mailing Address - Country:US
Mailing Address - Phone:732-829-3047
Mailing Address - Fax:
Practice Address - Street 1:890 COMMONS WAY BLDG H
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6430
Practice Address - Country:US
Practice Address - Phone:732-829-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00394700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00394700OtherLISCENSE