Provider Demographics
NPI:1598952400
Name:VASEL, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:VASEL
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 1:5 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-4313
Mailing Address - Country:US
Mailing Address - Phone:636-789-4305
Mailing Address - Fax:636-789-4309
Practice Address - Street 1:5 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-4313
Practice Address - Country:US
Practice Address - Phone:636-789-4305
Practice Address - Fax:636-789-4309
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist