MEDICARE: MS. LORI WEEKS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW60421223	WA
2	1041C0700X	Clinical Social Worker	I08388	NM

General Provider Information

NPI Number	:	1528478658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI WEEKS LICSW

Provider Business Mailing Address
First Line	:	611 LINCOLN ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-3136
Country	:	US
Telephone Number	:	928-890-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 LINCOLN ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-3136
Country	:	US
Telephone Number	:	928-890-8118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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