Provider Demographics
NPI:1902431380
Name:KING, LORI E (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-1039
Mailing Address - Country:US
Mailing Address - Phone:715-790-3951
Mailing Address - Fax:
Practice Address - Street 1:1190 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2044
Practice Address - Country:US
Practice Address - Phone:608-370-6551
Practice Address - Fax:608-370-6554
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9308-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical