Provider Demographics
NPI:1619573334
Name:LUDWIG, LORI KAE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAE
Last Name:LUDWIG
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 1:62024 DEAN SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6217
Mailing Address - Country:US
Mailing Address - Phone:541-410-6065
Mailing Address - Fax:
Practice Address - Street 1:62024 DEAN SWIFT RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6217
Practice Address - Country:US
Practice Address - Phone:541-410-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000104077175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist