Basic Information
| Provider Information | |||||||||
| NPI: | 1548560774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGORTER | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | S-LP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEGORTER-LAPOLLO | ||||||||
| OtherFirstName: | LORRAINE | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | S-LP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15711 101ST ST | ||||||||
| Address2: | |||||||||
| City: | HOWARD BEACH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114143205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187028652 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2534 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111033702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187775243 | ||||||||
| FaxNumber: | 7187775250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 10/21/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 020405 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.