Provider Demographics
NPI:1508236159
Name:KING, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KING
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 1:29 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5580
Mailing Address - Country:US
Mailing Address - Phone:207-743-8747
Mailing Address - Fax:207-743-6511
Practice Address - Street 1:29 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5580
Practice Address - Country:US
Practice Address - Phone:207-743-8747
Practice Address - Fax:207-743-6511
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL370237700000X
NHH611237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist