Provider Demographics
NPI:1710221494
Name:LORI TETSURO MCDONALD
Entity Type:Organization
Organization Name:LORI TETSURO MCDONALD
Other - Org Name:HEARING CENTER OF DEER PARK LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-276-8859
Mailing Address - Street 1:23 E CRAWFORD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006
Mailing Address - Country:US
Mailing Address - Phone:509-276-8859
Mailing Address - Fax:
Practice Address - Street 1:23 E CRAWFORD ST
Practice Address - Street 2:SUITE D
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty