Provider Demographics
NPI:1003970500
Name:MARLOW, LISA ANN (MACCC A)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:MARLOW
Suffix:
Gender:F
Credentials:MACCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15580 RIVERSIDE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-464-2595
Mailing Address - Fax:
Practice Address - Street 1:19991 HALL RD
Practice Address - Street 2:STE 102
Practice Address - City:MACOMB TWP
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-263-4401
Practice Address - Fax:586-263-4402
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000196231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist