Provider Demographics
NPI:1578872172
Name:MARSHALL, LISA M (HAD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:GOLD
Other - Middle Name:CANYON
Other - Last Name:HEARING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5331 S SUPERSTITION MOUNTAIN DR
Mailing Address - Street 2:SUITE C-107
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-1921
Mailing Address - Country:US
Mailing Address - Phone:480-983-4000
Mailing Address - Fax:480-983-4844
Practice Address - Street 1:5331 S SUPERSTITION MOUNTAIN DR
Practice Address - Street 2:SUITE C-107
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-1921
Practice Address - Country:US
Practice Address - Phone:480-983-4000
Practice Address - Fax:480-983-4844
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD 4304237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist