Provider Demographics
NPI:1164665816
Name:WINGFIELD, LISA MARY
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARY
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W. 162ND ST.
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085
Mailing Address - Country:US
Mailing Address - Phone:913-239-9670
Mailing Address - Fax:
Practice Address - Street 1:2360 W. 162ND ST.
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085
Practice Address - Country:US
Practice Address - Phone:913-239-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist