Provider Demographics
NPI:1386813467
Name:MOSER, LORI (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITNEY CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6132
Mailing Address - Country:US
Mailing Address - Phone:970-631-9471
Mailing Address - Fax:
Practice Address - Street 1:130 WHITNEY CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6132
Practice Address - Country:US
Practice Address - Phone:970-631-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09116633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09116633OtherASHA
CO55857043Medicaid