Provider Demographics
NPI:1124395702
Name:MAZENKO, LORI (MA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MAZENKO
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELLEN
Other - Last Name:MARQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0019
Mailing Address - Country:US
Mailing Address - Phone:541-490-1916
Mailing Address - Fax:
Practice Address - Street 1:1029 MAY ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1514
Practice Address - Country:US
Practice Address - Phone:541-490-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61067218101YP2500X
ORC3183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional