Provider Demographics
NPI:1366710162
Name:MCDONALD, LORI T (HIS, AAS)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:HIS, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-0249
Mailing Address - Country:US
Mailing Address - Phone:509-276-8859
Mailing Address - Fax:509-276-1495
Practice Address - Street 1:23 EAST CRAWFORD
Practice Address - Street 2:SUITE D
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-0249
Practice Address - Country:US
Practice Address - Phone:509-276-8859
Practice Address - Fax:509-276-1495
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA237700000X237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist