Provider Demographics
NPI:1457615890
Name:ROUNDS, LORIE RITA
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:RITA
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11975 W MID VALLEY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0634
Mailing Address - Country:US
Mailing Address - Phone:907-892-6114
Mailing Address - Fax:907-892-7972
Practice Address - Street 1:11975 W MID VALLEY WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:AK
Practice Address - Zip Code:99623-0634
Practice Address - Country:US
Practice Address - Phone:907-892-6114
Practice Address - Fax:907-892-7972
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK409107171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator