Provider Demographics
NPI:1114353836
Name:BARYENBRUCH, LISA (HIS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BARYENBRUCH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WASHINGTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5248
Mailing Address - Country:US
Mailing Address - Phone:920-686-0200
Mailing Address - Fax:920-686-0200
Practice Address - Street 1:1011 WASHINGTON ST STE 4
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5248
Practice Address - Country:US
Practice Address - Phone:920-686-0200
Practice Address - Fax:920-686-0200
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1142237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist