Provider Demographics
NPI:1831670017
Name:LOTITO, VIRGINIA S (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:S
Last Name:LOTITO
Suffix:
Gender:F
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 1:1643 COUNTY ROAD 3108
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-8079
Mailing Address - Country:US
Mailing Address - Phone:903-810-0222
Mailing Address - Fax:
Practice Address - Street 1:810 BELLAIRE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9045
Practice Address - Country:US
Practice Address - Phone:903-589-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist