Provider Demographics
NPI:1114967809
Name:LISENBEE, CATHERINE M (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:M
Last Name:LISENBEE
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:616-954-1895
Mailing Address - Fax:
Practice Address - Street 1:751 KENMOOR AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2391
Practice Address - Country:US
Practice Address - Phone:616-954-1895
Practice Address - Fax:616-954-2093
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI903336569Medicaid
MI903336569Medicaid
MIN71660029Medicare PIN