Provider Demographics
NPI:1699812354
Name:DUNDAS, LISA A (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S ELISEO DR
Mailing Address - Street 2:108
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2017
Mailing Address - Country:US
Mailing Address - Phone:415-461-9703
Mailing Address - Fax:415-461-9708
Practice Address - Street 1:1100 S ELISEO DR
Practice Address - Street 2:108
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2017
Practice Address - Country:US
Practice Address - Phone:415-461-9703
Practice Address - Fax:415-461-9708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU351231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA237600000XMedicaid
CA237600000XMedicaid