Basic Information
| Provider Information | |||||||||
| NPI: | 1043713498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14407 98TH WAY SE | ||||||||
| Address2: | |||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609729365 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S AVENUE K | ||||||||
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| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881307400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755624232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2018 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.