Provider Demographics
NPI:1326024241
Name:WEBER, LISA M (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHILDREN'S PLAZA
Mailing Address - Street 2:BOX #38
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-880-3603
Mailing Address - Fax:773-880-6618
Practice Address - Street 1:2300 CHILDREN'S PLAZA
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-3603
Practice Address - Fax:773-880-6618
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002299A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200398370Medicaid