Individual
LORI SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
208 PENNKNOLL RD, EVERETT, PA 15537-6940
(814) 623-3200
Mailing address
208 PENNKNOLL RD, EVERETT, PA 15537-6940
(814) 623-3200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL007005
PA
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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