Individual
MELODY KAY LORENZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
Mailing address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
CP00001048
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801018528
—
WA
Enumeration date
11/27/2018
Last updated
11/27/2018
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