Provider Demographics
NPI:1053621573
Name:LOCKRIDGE, KARIN (MS, CCC-A)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-257-1589
Mailing Address - Fax:404-303-1950
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 1280
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1699
Practice Address - Country:US
Practice Address - Phone:404-257-1589
Practice Address - Fax:404-303-1950
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003057231H00000X
IL147.000630231H00000X
NC9089231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC171WHOtherBCBS
NC9736865OtherAETNA
NC1570878OtherCIGNA
NC7413722Medicaid
SCSAN104Medicaid
NCQ38972AMedicare PIN