Provider Demographics
NPI:1255505848
Name:COTTRELL, LISA MARLETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARLETTE
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PORT WASHINGTON RD
Mailing Address - Street 2:AURORA MEDICAL CENTER - GRAFTON, SUITE 410
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9201
Mailing Address - Country:US
Mailing Address - Phone:262-329-4305
Mailing Address - Fax:262-329-5614
Practice Address - Street 1:975 PORT WASHINGTON RD
Practice Address - Street 2:AURORA MEDICAL CENTER - GRAFTON, SUITE 410
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-329-4305
Practice Address - Fax:262-329-5614
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2815-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43734900Medicaid