Provider Demographics
NPI:1720014319
Name:LAVOIE, MARY (AUDIOLOGIST/SPPATH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:AUDIOLOGIST/SPPATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5016
Mailing Address - Country:US
Mailing Address - Phone:530-885-0228
Mailing Address - Fax:530-885-7237
Practice Address - Street 1:1275 HIGH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5016
Practice Address - Country:US
Practice Address - Phone:530-885-0228
Practice Address - Fax:530-885-7237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1086231H00000X
CASP7250235Z00000X
CAHA1475237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0010860Medicaid