Provider Demographics
NPI:1326450370
Name:BISSON, LISA (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BISSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 MARVIN DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2930
Mailing Address - Country:US
Mailing Address - Phone:716-640-6713
Mailing Address - Fax:
Practice Address - Street 1:8579 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1411
Practice Address - Country:US
Practice Address - Phone:716-640-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2014164-SP235Z00000X
OHSP.11641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0239789Medicaid