Provider Demographics
NPI:1518149533
Name:COLE, LISA K (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:K
Last Name:COLE
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:KATIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 FOXFORD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089
Mailing Address - Country:US
Mailing Address - Phone:847-478-0631
Mailing Address - Fax:
Practice Address - Street 1:330 FOXFORD DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-478-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist