Provider Demographics
NPI:1578228870
Name:SORN, LISA SUE (MS, RD, CSR, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUE
Last Name:SORN
Suffix:
Gender:F
Credentials:MS, RD, CSR, LD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SUE
Other - Last Name:SWINEFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSR, LD
Mailing Address - Street 1:4859 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-237-7983
Mailing Address - Fax:
Practice Address - Street 1:4859 WILLOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011
Practice Address - Country:US
Practice Address - Phone:513-237-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD1194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered