Provider Demographics
NPI:1790672806
Name:WRIGHT, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WRIGHT
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 1:1122 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2118
Mailing Address - Country:US
Mailing Address - Phone:920-809-9093
Mailing Address - Fax:920-809-9093
Practice Address - Street 1:1122 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-2118
Practice Address - Country:US
Practice Address - Phone:920-809-9093
Practice Address - Fax:920-809-9093
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities