Individual
LORI GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 HIGHLAND DR, OGALLALA, NE 69153-1741
(605) 906-0863
Mailing address
1500 HIGHLAND DR, OGALLALA, NE 69153-1741
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12345678
NE
235Z00000X
Speech-Language Pathologist
12345678
SD
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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