Provider Demographics
NPI:1134191992
Name:LORD-SUNAMOTO, LAKESHA I (MS OTR/L, CLT)
Entity type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:I
Last Name:LORD-SUNAMOTO
Suffix:
Gender:F
Credentials:MS OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4702
Mailing Address - Country:US
Mailing Address - Phone:860-539-9202
Mailing Address - Fax:
Practice Address - Street 1:231 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1915
Practice Address - Country:US
Practice Address - Phone:860-677-0005
Practice Address - Fax:860-677-2727
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0011116OtherHEALTHNET
CT753168105OtherNORTHEAST HEALTHCARE
7788774OtherAETNA
CT11116OtherCIGNA
CT11544836OtherPROVIDER CAQH ID
CT130002842CT01OtherANTHEM BLUE CROSS BLUE SH
CT11116OtherCIGNA