Provider Demographics
NPI:1992044275
Name:ECKENRODE, LORI ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANNE
Last Name:ECKENRODE
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 1:1963 STACEY CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-4130
Mailing Address - Country:US
Mailing Address - Phone:386-256-0386
Mailing Address - Fax:
Practice Address - Street 1:4011 SR 46
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9721
Practice Address - Country:US
Practice Address - Phone:407-620-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist