Provider Demographics
NPI:1871820464
Name:EASTWOOD, LORI SR (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:EASTWOOD
Suffix:SR
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MOUNT LORETTA AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-8787
Mailing Address - Country:US
Mailing Address - Phone:563-588-0558
Mailing Address - Fax:583-557-3140
Practice Address - Street 1:1229 MOUNT LORETTA AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7826
Practice Address - Country:US
Practice Address - Phone:563-588-0558
Practice Address - Fax:583-557-3140
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker