Basic Information
| Provider Information | |||||||||
| NPI: | 1073162475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUILL | ||||||||
| FirstName: | LORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 RIVER RD | ||||||||
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| City: | SMITHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420819427 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 508 N HAYDEN AVE | ||||||||
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| City: | SALEM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420788008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709884572 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2019 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 139826 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.