Provider Demographics
NPI:1215609656
Name:LODERS, GARRETT MITCHELL
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:MITCHELL
Last Name:LODERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31914 3RD PL SW APT A
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-4695
Mailing Address - Country:US
Mailing Address - Phone:503-816-2307
Mailing Address - Fax:
Practice Address - Street 1:3704 N 35TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6033
Practice Address - Country:US
Practice Address - Phone:206-580-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician