Provider Demographics
NPI:1568738029
Name:LEBOUEF, LISA (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEBOUEF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1005
Mailing Address - Country:US
Mailing Address - Phone:715-258-5586
Mailing Address - Fax:
Practice Address - Street 1:N2665 COUNTY ROAD QQ
Practice Address - Street 2:SPEECH THERAPY DEPARTMENT
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946-0600
Practice Address - Country:US
Practice Address - Phone:715-258-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1922-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist