Individual
LORA LEE MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPC
Contact information
Practice address
1723 KRESKY AVE, CENTRALIA, WA 98531-8985
(360) 559-6201
(360) 807-4429
Mailing address
1723 KRESKY AVE, CENTRALIA, WA 98531-8985
(360) 559-6201
(360) 807-4429
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG60864636
WA
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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