Provider Demographics
NPI:1588861546
Name:TEIGEN, LORI RENEE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:RENEE
Last Name:TEIGEN
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:PO BOX 771011
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-1011
Mailing Address - Country:US
Mailing Address - Phone:352-620-5999
Mailing Address - Fax:352-873-1326
Practice Address - Street 1:11333 SW 50TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4404
Practice Address - Country:US
Practice Address - Phone:352-620-5999
Practice Address - Fax:352-873-1326
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA9361OtherSPEECH LANGUAGE LICENSE
GASLP004433OtherSTATE LICENSE
NC7680OtherNC LICENSE
FL892844400Medicaid