Provider Demographics
NPI:1962544403
Name:LODATO, MARION K (LAC)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:K
Last Name:LODATO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9353
Mailing Address - Country:US
Mailing Address - Phone:509-860-0229
Mailing Address - Fax:
Practice Address - Street 1:10171 CHUMSTICK HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-9267
Practice Address - Country:US
Practice Address - Phone:509-860-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist