Provider Demographics
NPI:1962733964
Name:NELSON, LORI JEAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2822
Mailing Address - Country:US
Mailing Address - Phone:630-204-3194
Mailing Address - Fax:
Practice Address - Street 1:132 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2822
Practice Address - Country:US
Practice Address - Phone:630-204-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist