Provider Demographics
NPI:1982842001
Name:LA DELLE-DALY, LOIS GRACE (QA ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:GRACE
Last Name:LA DELLE-DALY
Suffix:
Gender:F
Credentials:QA ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:631 S. DORA STREET
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-472-2010
Mailing Address - Fax:707-462-4931
Practice Address - Street 1:631 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5011
Practice Address - Country:US
Practice Address - Phone:707-467-2010
Practice Address - Fax:707-463-4931
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator