Provider Demographics
NPI:1306081674
Name:LOVATO, LORI LEIGH (MA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEIGH
Last Name:LOVATO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:LEIGH
Other - Last Name:LOSEY LOVATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAUD
Mailing Address - Street 1:924 N COLUMBIA CENTER BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-572-2444
Mailing Address - Fax:509-572-2124
Practice Address - Street 1:924 N COLUMBIA CENTER BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-572-2444
Practice Address - Fax:509-572-2124
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60062662237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038707Medicaid
WA0363392OtherLABOR AND INDUSTRIES
WA2038707Medicaid