Provider Demographics
NPI:1558414938
Name:PARK, LISA REGINA (AUD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:REGINA
Last Name:PARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 FORTUNES RIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6102
Practice Address - Country:US
Practice Address - Phone:919-419-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231H00000X
NC7316231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist