Provider Demographics
NPI:1245276542
Name:FERGUSON, LORIE (BS, ALACE TRAINED)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:BS, ALACE TRAINED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 OLD BRISTOW RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9606
Mailing Address - Country:US
Mailing Address - Phone:859-240-2098
Mailing Address - Fax:
Practice Address - Street 1:565 OLD BRISTOW RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-9606
Practice Address - Country:US
Practice Address - Phone:859-240-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER
KY610661458OtherFEDERAL TAX ID NUMBER