Provider Demographics
NPI:1629227087
Name:CARR, LORRI E (LM, CPM, LDM)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:E
Last Name:CARR
Suffix:
Gender:F
Credentials:LM, CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HIGHLANDER WAY
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-2629
Mailing Address - Country:US
Mailing Address - Phone:509-250-2072
Mailing Address - Fax:509-772-2626
Practice Address - Street 1:11 HIGHLANDER WAY
Practice Address - Street 2:BOX 800
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-2629
Practice Address - Country:US
Practice Address - Phone:509-250-2072
Practice Address - Fax:509-772-2626
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000320176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002892Medicaid