Provider Demographics
NPI:1114202132
Name:ADAMS, LISA BAUER (MS/CCC/SSLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BAUER
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS/CCC/SSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PORTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9113
Mailing Address - Country:US
Mailing Address - Phone:716-652-0403
Mailing Address - Fax:
Practice Address - Street 1:1500 PORTERVILLE RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9113
Practice Address - Country:US
Practice Address - Phone:716-652-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006549-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist