Provider Demographics
NPI:1427264225
Name:CLEMENTS, LORI ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MARKIEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:3060 SENTRY DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-8140
Mailing Address - Country:US
Mailing Address - Phone:859-344-9207
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-7232
Practice Address - Fax:859-301-7240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist