Provider Demographics
NPI:1316831860
Name:BATES, LORRETTA LOLA
Entity type:Individual
Prefix:
First Name:LORRETTA
Middle Name:LOLA
Last Name:BATES
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 1:7808 VAN DYKE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7331
Mailing Address - Country:US
Mailing Address - Phone:512-571-9569
Mailing Address - Fax:
Practice Address - Street 1:13642 N US HIGHWAY 183
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2265
Practice Address - Country:US
Practice Address - Phone:512-331-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist