Provider Demographics
NPI:1457501173
Name:ROEHL, LISA A (MA, CPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:ROEHL
Suffix:
Gender:F
Credentials:MA, CPC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-8900
Mailing Address - Fax:414-955-6285
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-8900
Practice Address - Fax:414-955-6285
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457501173Medicaid
WI43568500Medicaid