Provider Demographics
NPI:1588994404
Name:PHILLIPS, LORI D (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:D
Last Name:PHILLIPS
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 1:103 GEORGE ENDRIES DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2441
Mailing Address - Country:US
Mailing Address - Phone:518-355-8334
Mailing Address - Fax:
Practice Address - Street 1:2058 RENSSELAER AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4130
Practice Address - Country:US
Practice Address - Phone:518-952-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012216235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist