Provider Demographics
NPI:1417109554
Name:LA DUE, LISA MARIE (EARLY INTERVENTION)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LA DUE
Suffix:
Gender:F
Credentials:EARLY INTERVENTION
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:LA DUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7652 HARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4085
Mailing Address - Country:US
Mailing Address - Phone:727-424-5418
Mailing Address - Fax:
Practice Address - Street 1:7652 HARRINGTON LANE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-355-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist