Healthcare Provider Details

I. General information

NPI: 1164331609
Provider Name (Legal Business Name): LIDIA MARISOL LOZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N 7TH AVE
PASCO WA
99301-4174
US

IV. Provider business mailing address

2555 DUPORTAIL ST APT F348
RICHLAND WA
99352-4097
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-7848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: