Provider Demographics
NPI:1063699445
Name:GOERLITZ, LORI JENETTE (LAC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JENETTE
Last Name:GOERLITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JENETTE
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3506 243RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6500
Mailing Address - Country:US
Mailing Address - Phone:425-765-5005
Mailing Address - Fax:
Practice Address - Street 1:5825 221ST PL SE STE 206
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-765-5005
Practice Address - Fax:425-392-8338
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00001894171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist