Provider Demographics
NPI:1194030064
Name:LOVITZ, KATIE MARIE
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MARIE
Last Name:LOVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2514
Mailing Address - Country:US
Mailing Address - Phone:307-742-6641
Mailing Address - Fax:307-742-9203
Practice Address - Street 1:1150 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2514
Practice Address - Country:US
Practice Address - Phone:307-742-6641
Practice Address - Fax:307-742-9203
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator