Provider Demographics
NPI:1417401100
Name:GRIBLER, LISA LEA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEA
Last Name:GRIBLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 DAVIDSON DR
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-2502
Mailing Address - Country:US
Mailing Address - Phone:740-601-1655
Mailing Address - Fax:
Practice Address - Street 1:531 DAVIDSON DR
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-2502
Practice Address - Country:US
Practice Address - Phone:740-601-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21306658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist