Provider Demographics
NPI:1679007942
Name:MARKS, LORA
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N COUNTY ROAD 500 W
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9647
Mailing Address - Country:US
Mailing Address - Phone:317-431-5921
Mailing Address - Fax:765-378-9019
Practice Address - Street 1:1601 N COUNTY ROAD 500 W
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9647
Practice Address - Country:US
Practice Address - Phone:317-431-5921
Practice Address - Fax:765-378-9019
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004950A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist