Provider Demographics
NPI:1356687800
Name:PRAZAK, LISA SUSAN (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUSAN
Last Name:PRAZAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SUSAN
Other - Last Name:HOFHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 S. SCHEUBER RD
Mailing Address - Street 2:REHAB THERAPIES
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-330-8720
Mailing Address - Fax:360-330-8737
Practice Address - Street 1:1820 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-330-8720
Practice Address - Fax:360-330-8737
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60280882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist