Provider Demographics
NPI:1265623896
Name:LOVEJOY, EARL (MS CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:LOVEJOY
Suffix:
Gender:M
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 SE 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8272
Mailing Address - Country:US
Mailing Address - Phone:360-896-4997
Mailing Address - Fax:
Practice Address - Street 1:5601 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4601
Practice Address - Country:US
Practice Address - Phone:503-761-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10850235Z00000X
WALL00003546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR018486Medicaid