Individual
MRS. LORI LEAH BUBENHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
4203 BELFORT RD STE 340, JACKSONVILLE, FL 32216-1409
(904) 880-0911
(904) 880-9388
Mailing address
11945 SAN JOSE BLVD, JACKSONVILLE, FL 32223-1613
(904) 396-1725
(904) 396-4893
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY727
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104898500
—
FL
Enumeration date
03/18/2006
Last updated
12/08/2021
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