Provider Demographics
NPI:1255323036
Name:HEGG, LISA SUE (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SUE
Last Name:HEGG
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1782
Mailing Address - Country:US
Mailing Address - Phone:812-425-1500
Mailing Address - Fax:812-425-0587
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:SUITE #300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-425-1500
Practice Address - Fax:812-425-0587
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002197A231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000192940OtherANTHEM BLUE CROSS BLUE SH
IN000000192940OtherANTHEM BLUE CROSS BLUE SH