Provider Demographics
NPI:1417023870
Name:HAUTER, LISA (LCSW CSADF)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:HAUTER
Suffix:
Gender:F
Credentials:LCSW CSADF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SOUTH LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626
Mailing Address - Country:US
Mailing Address - Phone:217-854-3166
Mailing Address - Fax:217-854-9729
Practice Address - Street 1:320 SOUTH LOCUST STREET
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626
Practice Address - Country:US
Practice Address - Phone:217-854-3166
Practice Address - Fax:217-854-9729
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204312Medicare ID - Type Unspecified