1881731628 NPI number — MISS LORI ANN GRAEBE SLP

Table of content: MISS LORI ANN GRAEBE SLP (NPI 1881731628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881731628 NPI number — MISS LORI ANN GRAEBE SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAEBE
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROCACCINI
Provider Other First Name:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881731628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 HOFFMAN LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-761-8343
Provider Business Mailing Address Fax Number:
631-630-5622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 HOFFMAN LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-761-8343
Provider Business Practice Location Address Fax Number:
631-630-5622
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  014350 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 58-014350-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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