Provider Demographics
NPI:1588821409
Name:LAVOIE, KIMBERLY J (MS CCCA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17704 JEAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-699-0370
Mailing Address - Fax:503-699-2573
Practice Address - Street 1:17704 JEAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-699-0370
Practice Address - Fax:503-699-2573
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP774606237600000X
OR22363231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2212496Medicaid
OR500608486Medicaid