Provider Demographics
NPI:1649530387
Name:ABELSON, LORI HASKINS (CCC/SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:HASKINS
Last Name:ABELSON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARKSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1635
Mailing Address - Country:US
Mailing Address - Phone:518-877-6322
Mailing Address - Fax:518-877-6322
Practice Address - Street 1:40 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4807
Practice Address - Country:US
Practice Address - Phone:518-328-5101
Practice Address - Fax:518-274-4585
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004731-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist