Provider Demographics
NPI:1902046469
Name:CHATMON, LORA (MS/CCC/SLP)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:CHATMON
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CHRISTINE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5782
Mailing Address - Country:US
Mailing Address - Phone:256-235-3050
Mailing Address - Fax:
Practice Address - Street 1:1010 CHRISTINE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5782
Practice Address - Country:US
Practice Address - Phone:256-235-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 2147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist