Provider Demographics
NPI:1720187107
Name:BEHRINGER, LISA RENEE (MA, FAAA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENEE
Last Name:BEHRINGER
Suffix:
Gender:F
Credentials:MA, FAAA, CCC-A
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, FAAA, CCC-A
Mailing Address - Street 1:19110 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3702
Mailing Address - Country:US
Mailing Address - Phone:301-977-6317
Mailing Address - Fax:301-977-8503
Practice Address - Street 1:6020 MEADOWRIDGE CENTER DR
Practice Address - Street 2:STE C
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6528
Practice Address - Country:US
Practice Address - Phone:410-885-6700
Practice Address - Fax:410-885-6821
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00721237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407PMedicare PIN
MD807GMedicare PIN