Provider Demographics
NPI:1295099661
Name:GROAT, LORI JOANN (MA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JOANN
Last Name:GROAT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JOANN
Other - Last Name:GUARDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 E 4500 S
Mailing Address - Street 2:SUITE # F125
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2995
Mailing Address - Country:US
Mailing Address - Phone:801-268-1564
Mailing Address - Fax:801-268-1565
Practice Address - Street 1:525 E 4500 S
Practice Address - Street 2:SUITE # F125
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2995
Practice Address - Country:US
Practice Address - Phone:801-268-1564
Practice Address - Fax:801-268-1565
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8100590-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8100590-6009OtherSTATE OF UTAH