Healthcare Provider Details

I. General information

NPI: 1740647163
Provider Name (Legal Business Name): DEONNA LOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 GRIFFIN LN SE
OLYMPIA WA
98501-2192
US

IV. Provider business mailing address

PO BOX 706
MCKENNA WA
98558-0706
US

V. Phone/Fax

Practice location:
  • Phone: 360-402-7990
  • Fax:
Mailing address:
  • Phone: 253-861-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: