Provider Demographics
NPI:1679858534
Name:NOWORATZKY, LISA M (MS, MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NOWORATZKY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:NOWORATZKY-ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:926 S. 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220
Mailing Address - Country:US
Mailing Address - Phone:920-645-1939
Mailing Address - Fax:
Practice Address - Street 1:926 S. 8TH ST.
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220
Practice Address - Country:US
Practice Address - Phone:920-645-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist