Provider Demographics
NPI:1548933161
Name:DELISLE, LOREN
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:DELISLE
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 1:45 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2427
Mailing Address - Country:US
Mailing Address - Phone:413-335-1440
Mailing Address - Fax:
Practice Address - Street 1:757 LONG POINT RD STE D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8328
Practice Address - Country:US
Practice Address - Phone:803-292-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist