Provider Demographics
NPI:1639550197
Name:HONG-LISHNER, PHAN YEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHAN
Middle Name:YEN
Last Name:HONG-LISHNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6144 AEROTECH DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7503
Mailing Address - Country:US
Mailing Address - Phone:920-230-2065
Mailing Address - Fax:
Practice Address - Street 1:W6144 AEROTECH DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-7503
Practice Address - Country:US
Practice Address - Phone:920-230-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2650-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical