Provider Demographics
NPI:1548487721
Name:HALVERSON, LORRIE
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:HALVERSON
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 1:4310 CLEARBROOK LN N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8404
Mailing Address - Country:US
Mailing Address - Phone:252-230-7901
Mailing Address - Fax:252-991-6236
Practice Address - Street 1:4310 CLEARBROOK LN N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8404
Practice Address - Country:US
Practice Address - Phone:252-230-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135J4OtherBCBS
NC7412057Medicaid