Provider Demographics
NPI:1902055940
Name:HALLETT, LORI (MA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:HALLETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-431-6626
Mailing Address - Fax:562-493-6918
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-431-6626
Practice Address - Fax:562-493-6918
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2059237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter