Provider Demographics
NPI:1346683158
Name:PAULSON, LISA E (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W BLODGETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-2005
Mailing Address - Country:US
Mailing Address - Phone:912-604-8149
Mailing Address - Fax:
Practice Address - Street 1:310 W BLODGETT ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2005
Practice Address - Country:US
Practice Address - Phone:912-604-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI06663225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist