Provider Demographics
NPI:1578199352
Name:LORENZ, ELBERETH GILTHONIEL (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELBERETH
Middle Name:GILTHONIEL
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 SOUTHWICK CT SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-1819
Mailing Address - Country:US
Mailing Address - Phone:206-384-9877
Mailing Address - Fax:
Practice Address - Street 1:7440 JAMES RD SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-5102
Practice Address - Country:US
Practice Address - Phone:360-273-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60890872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist