Provider Demographics
NPI:1245587492
Name:MARAKA, LISA A (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:MARAKA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 ALGOMA RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKEN
Mailing Address - State:WI
Mailing Address - Zip Code:54229-9728
Mailing Address - Country:US
Mailing Address - Phone:920-217-2931
Mailing Address - Fax:
Practice Address - Street 1:3744 ALGOMA RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKEN
Practice Address - State:WI
Practice Address - Zip Code:54229-9728
Practice Address - Country:US
Practice Address - Phone:920-217-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3519-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist