Provider Demographics
NPI:1598798944
Name:WENSTRUP, LISA HOUSTON (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HOUSTON
Last Name:WENSTRUP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-475-8400
Practice Address - Fax:513-475-8228
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01421231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist