Provider Demographics
NPI:1568096394
Name:MEYER, LISA ROBERTA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROBERTA
Last Name:MEYER
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:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53088-0393
Mailing Address - Country:US
Mailing Address - Phone:920-379-7428
Mailing Address - Fax:
Practice Address - Street 1:325 S. MILITARY RD.
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53088
Practice Address - Country:US
Practice Address - Phone:920-379-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI347C00000X, 372600000X, 373H00000X, 3747P1801X, 374U00000X, 376J00000X, 385HR2055X, 385HR2060X, 385HR2065X, 385H00000X, 251C00000X, 253Z00000X, 261QA0600X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332U00000XSuppliersHome Delivered Meals