Provider Demographics
NPI:1528359379
Name:SAVAGE-TIBBOTT, LORRAINE TRACY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:TRACY
Last Name:SAVAGE-TIBBOTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PARKER WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2599
Mailing Address - Country:US
Mailing Address - Phone:360-424-9645
Mailing Address - Fax:360-428-3915
Practice Address - Street 1:1501 PARKER WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2599
Practice Address - Country:US
Practice Address - Phone:360-424-9645
Practice Address - Fax:360-428-3915
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00004209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist