Healthcare Provider Details

I. General information

NPI: 1588821409
Provider Name (Legal Business Name): KIMBERLY J LAVOIE MS CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17704 JEAN WAY SUITE 101
LAKE OSWEGO OR
97035
US

IV. Provider business mailing address

17704 JEAN WAY SUITE 101
LAKE OSWEGO OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-699-0370
  • Fax: 503-699-2573
Mailing address:
  • Phone: 503-699-0370
  • Fax: 503-699-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22363
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHASP774606
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: