Individual
LORI J. KINCANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
600 MOYE BLVD, GREENVILLE, NC 27834-4300
(252) 744-6104
(252) 744-6148
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5957
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1611T
BCBSNC
NC
05
—
7412329
—
NC
Enumeration date
02/23/2011
Last updated
11/02/2021
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