Provider Demographics
NPI:1639249360
Name:RICKARD, LISA (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RICKARD
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:399 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1255
Mailing Address - Country:US
Mailing Address - Phone:413-545-3669
Mailing Address - Fax:413-545-0803
Practice Address - Street 1:358 N PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1746
Practice Address - Country:US
Practice Address - Phone:413-545-3669
Practice Address - Fax:413-545-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA847231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist