Provider Demographics
NPI:1609360056
Name:BUCK, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUCK
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 1:206 E WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1324
Mailing Address - Country:US
Mailing Address - Phone:573-588-4165
Mailing Address - Fax:
Practice Address - Street 1:301 N EAST ST
Practice Address - Street 2:
Practice Address - City:GREEN CITY
Practice Address - State:MO
Practice Address - Zip Code:63545-1005
Practice Address - Country:US
Practice Address - Phone:660-874-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist