Provider Demographics
NPI:1902479603
Name:SIEGESMUND, LORI MICHELLE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:SIEGESMUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 PATTERSON RD STE 2-267
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8814
Mailing Address - Country:US
Mailing Address - Phone:970-208-9009
Mailing Address - Fax:
Practice Address - Street 1:2591 LEGACY WAY UNIT 403
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-1789
Practice Address - Country:US
Practice Address - Phone:970-208-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications