Provider Demographics
NPI:1184854986
Name:LISANNE S. CRAVEN AND ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LISANNE S. CRAVEN AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISANNE
Authorized Official - Middle Name:SIMMS
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:502-893-1285
Mailing Address - Street 1:2028 STRATHMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2528
Mailing Address - Country:US
Mailing Address - Phone:502-893-1285
Mailing Address - Fax:
Practice Address - Street 1:2028 STRATHMOOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2528
Practice Address - Country:US
Practice Address - Phone:502-893-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty